Speaker: Infections in kidney disease remain a challenge
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Improving the treatment of bacterial and viral infections, including those seen during the dialysis process, poses unique challenges to patients and staff, according to a speaker.
“Every time we developed a new drug, we would find resistance to the drug shortly after its discovery,” Aileen Ahiskali, PharmD, BCIDP, an antimicrobial stewardship pharmacist at Hennepin Healthcare, said at the American Nephrology Nurses Association Nephrology Nursing Practice, Management and Leadership Conference.
While Sir Alexander Fleming unintentionally discovered penicillin in 1928, it was Anne Miller who was hospitalized in 1942 for a month with a severe streptococcal infection that brought the new drug to the attention of the medical world. Miller’s doctors obtained a small amount of the drug which enabled Miller to become the first person to be saved by penicillin, Ahiskali said.
“Unfortunately, less than 1 year later, penicillin-resistant Staphylococcus aureus was first identified ...[but] Miller lived a full life and died at the ripe old age of 90,” she said.
Today, many health care settings still face the threat of infectious disease as treatments eventually give way to resistant bacteria, Ahiskali said.
Vancomycin was developed in 1958; Enterococcus faecium became resistant to the treatment in 1988 and Staphylococcus aureus in 2002. Escherichia coli was discovered to be resistant in 1983 to cefotaxime, which was released 3 years earlier in 1980. The result of resistance to treatment has led to the deaths of millions of people each year in the U.S. who are infected with antibiotic-resistant bacteria, said Ahiskali.
“We do see a recurring theme,” she said.
Patients with chronic kidney disease, including those on dialysis, and patients with a transplant, face higher risks for infection, Ahiskahi said. Vascular access and associated infections, plus increased rates of colonization/infection with multidrug-resistant organisms has led to vancomycin-resistant enterococci in North American dialysis centers.
“Defects in cellular immunity, neutrophil function and complement activation, plus increased health care exposure and hospitalizations lead to a great risk for infection,” she said.
Likewise, treatment options are far off because pharmaceutical companies may not always see value of investing research funds into drugs that will not substantially improve their bottom line, she said.
Additionally, a MRSA vaccine is another good example of a slow research effort.
“Earlier this year, researchers at [New York University] NYU published a study in mice in which they neutralized leucocidin-mediated immune subversion by vaccination, with positive results. However, given this was an animal study, we are still years away from potential human trials. So, we keep waiting,” she said.
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Ahiskali A. Session 130. Presented at the American Nephrology Nurses Association Nephrology Nursing Practice, Management and Leadership Conference, Nov. 7-8, 2020 (virtual).
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