The effect of patient age and other factors on the maintenance of permanent hemodialysis vascular access.

The objective of the present study was to investigate whether patient age is associated with vascular access failure during maintenance hemodialysis. Thus, patients who had a successful permanent hemodialysis vascular access installed (Group N: 314 cases), and those who required vascular access revision (Group R: 108 patients) were studied. To assess the association between patient age and the risk of vascular access failure, Cox proportional hazards regression was used to determine hazard ratios (HR) and 95% confidence intervals (CI). We found that in Group N, the significant risk factors were age, gender, and diabetes mellitus (95% CI: 1.004-1.013, 0.380-0.827, 1.279-2.859). Using a univariate analysis model, significant hazard ratios (HR) were found with ages of 60 (CI: 1.062-2.302), 65 (CI: 1.052-2.280), and 70 (CI: 1.082-2.537) years, with the largest HR at 70 years of age (HR: 1.657). In contrast, in Group R, multivariate analysis using Cox proportional hazards identified only one prognostic variable, the location of the vascular access. In Group R, univariate analysis models showed that age was not a significant factor. We conclude that our data show that age is a risk factor for the successful maintenance of initial permanent hemodialysis vascular access. Other risk factors include gender and diabetes mellitus. However, these factors were not related to the successful maintenance of revised vascular access.

Survey of the susceptibility of urinary isolates to antibacterial agents in 2003.

In 2003, 826 uropathogenic strains were obtained from the urine of our patients. We assessed their activities to antibacterial agents based on the minimal inhibitory concentration (MIC) breakpoints recommended by the National Committee for Clinical Standards (NCCLS). Methicillin-resistant strains accounted for about 70% of Staphylococcus aureus and Staphylococcus epidermidis. The most common gram-positive species was Enterococcus faecalis (15.6%). Enterococcus faecium was the most resistant of the enterococcal species, and the rate of susceptibility to beta-lactams (BLs), fluoroquinolones (FQs), and tetracyclines (TCs) was 0%, 6%, and less than 18%, respectively. Escherichia coli accounted for over 50% of the gram-negative bacilli. The proportion of FQ-resistant or intermediate strains was over 20%, and four of these strains (1.1%) were suspected of producing extended-spectrum beta-lactamase (ESBL). All the ESBL-producing strains (ESBLs) possess resistance to FQs. Over 95% of Klebsiella pneumoniae was susceptible to all agents. The distribution of antimicrobial activity against Pseudomonas aeruginosa indicated a decrease in the number of multidrug-resistant strains and an increase in strains susceptible to all agents. Some differences existed in the resistance to antibacterial agents among Proteus species. No ESBL-producing or multidrug-resistant strain was isolated from Serratia marcescens. This survey suggests that serious clinical problems will result from the increasing number of enterococcal species with multidrug resistance in gram-positive cocci, and isolates of ESBL-producing or FQs-resistant strains in gram-negative bacilli.

[Epidemiological study of methicillin-resistant Staphylococcus aureus isolated from the urology ward in 2003--nosocomial infection and community-acquired infection].

Methicillin-Resistant Staphylococcus aureus (MRSA) strains with the exception of urinary strains were isolated from the inpatients in urology ward hospitalized in 2003 and medical workers. Biotype according to the production of coagulase, enterotoxin and mupirocin sensitivity, and genotype by pulsed field gel electrophoresis (PFGE), and clinical background were determined for the MRSA strains to analyze the transmission route of the infection. In 34 medical workers in urology ward, MRSA were isolated in 6 (17.6%) workers from the nasal cavity, and the rate of colonization in doctors was higher than in nurses. Furthermore, mupirocin-resistant strains were isolated from two medical workers. 18 MRSA strains were isolated in 2003 and the accounting was 8 strains from wounds, 6 strains from sputum or nasal cavity, 3 strains from blood, and 2 strains from urinary tract. Most of the patients with MRSA had operations under general anesthesia or were under severe conditions with malignant tumors. No MRSA was detected at the same time from the same rooms. There were some rooms in which the MRSA detected rate was high, however no MRSA was isolated from hospital environments and dumping bacteria. These results suggest that the involvement of the medical workers and the spread of MRSA in the society might be important as infection source and for transmission of MRSA in hospital.

[The trend and susceptibility to antibacterial agents of enterococcus species from urinary tract infections].

OBJECTIVE: To determine the extent of drug-resistance among Enterococcus species we investigated in vitro experiments. METHODS: Studies were carried out on pure cultured of enterococci isolated from 8,575 urine specimens between 1990 and 2002. We had determined test strains to three kinds of species, which posses the urinary pathogenesis. Both an EF-agars and an ADH decarboxylase test performed the identification and speciation of the strains of enterococci. In vitro drug-susceptibility tests of enterococci were performed against the following antibiotics: ampicillin (ABPC), cefpirome (CPR), cefozopran (CZOP), imipenem/cilastatin (IPM/CS), minocycline (MINO), levofloxacin (LVFX), vancomycin (VCM), sulfamethoxazone/trimethoprim (ST), by employing the method for dilution antimicrobial susceptibility tests for bacteria that grow aerobically recommended by Japan Society of Chemotherapy. These drug-susceptibilities were shown susceptible, intermittent and resistant in according to National Committee for Clinical Laboratory Standards (M100-S12). RESULTS: The most common species isolated was E. faecalis (84.4%), followed by E. faecium (9.9%) and E. avium (5.6%). In E. faecium and E. avium, the sensitivity to ABPC has tended to improve from 1999. This tendency inverse correlated to decreasing dosage of PCs. There was much difference of resistant rate to IPM/CS between each species, and no correlation to used dosage of CBPs. The rate of resistance to MINO did not change during this period. 60% of E. faecalis had sensitivity to LVFX and the rate did not change during this period. In E. faecium, whose resistant rate to LVFX was 90%, the sensitivity has been improved to over 25% from 2001. The improved tendency of E. faecium to LVFX has inverse proportion to decreasing dosage of NQs. With the exception of a little bit VRE (VCM resistant Enterococci), almost of them had sensitivity to VCM. CONCLUSION: The emergence of enterococci with alarming rates of resistance concomitantly to multi-drugs highlights the need for a more rational and restricted use of antimicrobials, in order to minimize the selection and spread of such strains. An early detection of these problem pathogens is also important for preventing any treatment failures.