Abstract
ABSTRACTThe emergence of resistance mechanisms not only limits the therapeutic options for common bacterial infections but also worsens the prognosis in patients who have conditions that increase the risk of bacterial infections. Thus, the effectiveness of important medical advances that seek to improve the quality of life of patients with chronic diseases is threatened. We report the simultaneous colonization and bacteremia by multidrug-resistant bacteria in two hemodialysis patients. The first patient was colonized by carbapenem- and colistin-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA). The patient had a bacteremia by MRSA, and molecular typing methods confirmed the colonizing isolate was the same strain that caused infection. The second case is of a patient colonized by extended-spectrum beta-lactamases (ESBL)-producing Escherichia coli and carbapenem-resistant Pseudomonas aeruginosa. During the follow-up period, the patient presented three episodes of bacteremia, one of these caused by ESBL-producing E. coli. Molecular methods confirmed colonization by the same clone of ESBL-producing E. coli at two time points, but with a different genetic pattern to the strain isolated from the blood culture. Colonization by multidrug-resistant bacteria allows not only the spread of these microorganisms, but also increases the subsequent risk of infections with limited treatments options. In addition to infection control measures, it is important to establish policies for the prudent use of antibiotics in dialysis units.
Highlights
Antimicrobial resistance has complicated the treatment of patients with bacterial infections by limiting the available options[1, 2]
Patients with chronic renal failure on hemodialysis are highly susceptible to colonization and development of bacterial infections, with percentages exceeding those reported in individuals with other types of exposure to health care[4]
We report the simultaneous colonization and bacteremia by multidrug-resistant bacteria in two hemodialysis patients included in a cohort study in which colonization by these microorganisms in stool, nostrils, and skin was evaluated at three timepoints, in a renal unit of Medellín, Colombia
Summary
Antimicrobial resistance has complicated the treatment of patients with bacterial infections by limiting the available options[1, 2]. Patients with chronic renal failure on hemodialysis are highly susceptible to colonization and development of bacterial infections, with percentages exceeding those reported in individuals with other types of exposure to health care[4]. We report the simultaneous colonization and bacteremia by multidrug-resistant bacteria in two hemodialysis patients included in a cohort study in which colonization by these microorganisms in stool, nostrils, and skin was evaluated at three timepoints (at the beginning of the study, at month two and month six), in a renal unit of Medellín, Colombia.
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