Vancomycin intermediate and resistant Staphylococcus aureus. What the nephrologist needs to know.

Individuals undergoing hemodialysis may be at increased risk for emerging antimicrobial resistance from vancomycin-intermediate Staphylococcus aureus (VISA) and vancomycin-resistant S. aureus (VRSA). The laboratory detection of VISA and VRSA is challenging and requires the use of well-thought-out algorithms. Newly available antimicrobials such as quinipristin/dalfopristin, linezolid, and daptomycin, as well as older drugs such as trimethoprim-sulfamethoxazole appear to be active against recent strains of VISA and VRSA. Prevention of VISA and VRSA necessitates determining the appropriateness of vancomycin use in renal patients and giving priority to infection control precautions in both inpatient and outpatient settings. Because most VISA and all VRSA to date have arisen from endemic methicillin-resistant S. aureus (MRSA), and in the case of VRSA have acquired genes from vancomycin-resistant enterococci (VRE), the emergence of VISA and VRSA should provide renewed motivation for the containment of MRSA and VRE transmission in the hemodialysis population.