Urgent-Start Peritoneal Dialysis: A Quality Improvement Report.
Am J Kidney Dis. 2011 Oct 21;
Authors: Ghaffari A
Abstract
BACKGROUND: Compared with hemodialysis, peritoneal dialysis (PD) is a cost-effective an…

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Decongestive Treatment of Acute Decompensated Heart Failure: Cardiorenal Implications of Ultrafiltration and Diuretics.
Am J Kidney Dis. 2011 Oct 17;
Authors: Freda BJ, Slawsky M, Mallidi J, Braden GL
Abstract
…

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Hyponatremia in Hospitalized Cancer Patients and Its Impact on Clinical Outcomes.
Am J Kidney Dis. 2011 Oct 14;
Authors: Doshi SM, Shah P, Lei X, Lahoti A, Salahudeen AK
Abstract
BACKGROUND: Hyponatremia is the…

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Therapeutic Response to Vasoconstrictors in Hepatorenal Syndrome Parallels Increase in Mean Arterial Pressure: A Pooled Analysis of Clinical Trials.
Am J Kidney Dis. 2011 Sep 28;
Authors: Velez JC, Nietert PJ
Abstract
…

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Comparison of Measured GFR, Serum Creatinine, Cystatin C, and Beta-Trace Protein to Predict ESRD in African Americans With Hypertensive CKD.
Am J Kidney Dis. 2011 Sep 21;
Authors: Bhavsar NA, Appel LJ, Kusek JW, Contreras G, B…

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The Risk of Infection-Related Hospitalization With Decreased Kidney Function.
Am J Kidney Dis. 2011 Sep 7;
Authors: Dalrymple LS, Katz R, Kestenbaum B, de Boer IH, Fried L, Sarnak MJ, Shlipak MG
Abstract
BACKGR…

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Venous Thromboembolism in Patients With Reduced Estimated GFR: A Population-Based Perspective.
Am J Kidney Dis. 2011 Aug 26;
Authors: Parikh AM, Spencer FA, Lessard D, Emery C, Baylin A, Linkletter C, Goldberg RJ
Abstr…

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?-Blockers for Prevention of Sudden Cardiac Death in Patients on Hemodialysis: A Propensity Score Analysis of the HEMO Study.
Am J Kidney Dis. 2011 Aug 26;
Authors: Tangri N, Shastri S, Tighiouart H, Beck GJ, Cheung AK, Eknoy…

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The Role of Functional Status in Discharge to Assisted Care Facilities and In-Hospital Death Among Dialysis Patients.
Am J Kidney Dis. 2011 Aug 4;
Authors: Sood MM, Rigatto C, Bueti J, Jassal V, Miller L, Verrelli M, Bohm C, M…

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Approach to the Evaluation of a Patient With an Increased Serum Osmolal Gap and High-Anion-Gap Metabolic Acidosis.
Am J Kidney Dis. 2011 Jul 26;
Authors: Kraut JA, Xing SX
An increase in serum osmolality and serum osmo…

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Volume Depletion Versus Dehydration: How Understanding the Difference Can Guide Therapy.
Am J Kidney Dis. 2011 Jun 24;
Authors: Bhave G, Neilson EG
Although often used interchangeably, dehydration and volume depletion …

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Cystatin C in Prediction of Acute Kidney Injury: A Systemic Review and Meta-analysis.
Am J Kidney Dis. 2011 May 19;
Authors: Zhang Z, Lu B, Sheng X, Jin N
BACKGROUND: Cystatin C (CysC) has been proposed as a filtration…

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Relapsing and Recurrent Peritoneal Dialysis-Associated Peritonitis: A Multicenter Registry Study.
Am J Kidney Dis. 2011 May 19;
Authors: Burke M, Hawley CM, Badve SV, McDonald SP, Brown FG, Boudville N, Wiggins KJ, Bannister K…

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Clinical Applications of Biomarkers for Acute Kidney Injury.
Am J Kidney Dis. 2011 Mar 14;
Authors: Belcher JM, Edelstein CL, Parikh CR
Research into novel therapies for acute kidney injury (AKI) has been hampered by r…

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Management of Gram-Positive Coccal Bacteremia and Hemodialysis.

Am J Kidney Dis. 2011 Feb 16;

Authors: Fitzgibbons LN, Puls DL, Mackay K, Forrest GN

Gram-positive cocci are the most common cause of bloodstream infections in hemodialysis patients, with Staphylococcus aureus and coagulase-negative staphylococci causing most infections. Management of these infections often is complicated by limited vascular access options, as well as an increasing prevalence of drug-resistant bacteria in hemodialysis centers, including the emergence of strains of methicillin-resistant S aureus with vancomycin heteroresistance and increasing rates of vancomycin-resistant enterococci, both of which have limited antibiotic treatment options. This article describes the management of these infections based on the organism and its susceptibility profile, including catheter management, antibiotic lock therapies, and systemic antibiotic choices. Although coagulase-negative staphylococci bacteremia often may be managed with preservation of the catheter, antibiotic lock therapy, and intravenous antibiotics, this is rarely the case with S aureus bacteremia because of frequent relapse and the risk of complications, including endocarditis. Enterococcal bacteremia requires more individualization of care, but catheters are less likely to be salvaged, especially when vancomycin-resistant Enterococcus is the causative organism. Finally, strong infection control policies in the hemodialysis unit, conversion from catheter to arteriovenous access when possible, and appropriate use of antibiotics are essential factors in the prevention of these bloodstream infections.

PMID: 21333430 [PubMed - as supplied by publisher]

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