Retrospective Analysis of Spectrum of Infections and Antibiotic Resistance Pattern in Chronic Kidney Disease Patients on Maintenance Hemodialysis in a Tertiary Care Centre in North India

Overview

Journal Indian J Nephrol

Specialty Nephrology

Date 2023 Jul 14

PMID 37448889

Authors

Malsawmkima Chhakchhuak

Manish Chaturvedy

Jony Agarwal

Vibhor Tak

Nitin K Bajpai

Affiliations

Soon will be listed here.

Abstract

Introduction: Hemodialysis patients are at risk of infections. This study examines the spectrum of infections and antibiotic resistance patterns.

Methods: We retrospectively reviewed the records of 586 hemodialysis patients from May 2018 to April 2020 in a tertiary care hospital in North India.

Results: The study identified 99 episodes of confirmed infections. Urinary tract infections were the most common type of infections (55.5%), followed by catheter-related bloodstream infections (CRBSI) (definitive 21.2%). Other infections were pneumonia (8.1%), tuberculosis (6.1%), skin and soft tissue infection (4.0%), dengue fever (3.03%), and empyema thoracis (1.0%). Overall, (33.3%) was the most common organism isolated. The most frequent uropathogens recovered were (54%). In confirmed CRBSI, (23.8%) and MSSA (23.8%) were the most common pathogen isolated. (37.5%) was the most common pathogen in pneumonia. Uropathogens showed the highest resistance to fluoroquinolones (93.3%-100%). Pathogens isolated in CRBSI showed maximum resistance to ciprofloxacin (100%). In pneumonia, the highest resistance was seen to third-generation cephalosporins (75%-100%).

Conclusion: Though the bacterial spectrum remains the same over time, antibiotic resistance is changing in uropathogens. There is a trend of predominance of Gram-negative bacterial infections in CRBSI. Tuberculosis incidence rate was much higher than the general population. There is a need for nationwide and worldwide continuous surveillance.

References

Sibbel S, Sato R, Hunt A, Turenne W, Brunelli S . The clinical and economic burden of pneumonia in patients enrolled in Medicare receiving dialysis: a retrospective, observational cohort study. BMC Nephrol. 2016; 17(1):199. PMC: 5153919. DOI: 10.1186/s12882-016-0412-6. View

Ahmed A, Karter A . Tuberculosis in California dialysis patients. Int J Tuberc Lung Dis. 2004; 8(3):341-5. View

Vikrant S . Clinical profile of tuberculosis in patients with chronic kidney disease: A report from an endemic Country. Saudi J Kidney Dis Transpl. 2019; 30(2):470-477. DOI: 10.4103/1319-2442.256854. View

Jaber B . Bacterial infections in hemodialysis patients: pathogenesis and prevention. Kidney Int. 2005; 67(6):2508-19. DOI: 10.1111/j.1523-1755.2005.00364.x. View

Chen C, Hsu W, Chen H, Chen W, Shih C, Hsia T . Different bacteriology and prognosis of thoracic empyemas between patients with chronic and end-stage renal disease. Chest. 2007; 132(2):532-9. DOI: 10.1378/chest.07-0005. View

Al-Solaiman Y, Estrada E, Allon M . The spectrum of infections in catheter-dependent hemodialysis patients. Clin J Am Soc Nephrol. 2011; 6(9):2247-52. PMC: 3359000. DOI: 10.2215/CJN.03900411. View

Hoen B, Hestin D, Kessler M . EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998; 9(5):869-76. DOI: 10.1681/ASN.V95869. View

Shah S, Singhal T, Naik R, Thakkar P . Incidence and Etiology of Hemodialysis Catheter Related Blood Stream Infections at a Tertiary Care Hospital in Mumbai: A 5 Year Review. Indian J Nephrol. 2020; 30(2):132-133. PMC: 7132842. DOI: 10.4103/ijn.IJN_127_19. View

Sarnak M, Jaber B . Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000; 58(4):1758-64. DOI: 10.1111/j.1523-1755.2000.00337.x. View

10.

DAgata E, Mount D, Thayer V, Schaffner W . Hospital-acquired infections among chronic hemodialysis patients. Am J Kidney Dis. 2000; 35(6):1083-8. DOI: 10.1016/s0272-6386(00)70044-8. View

11.

Lui S, Tang S, Li F, Choy B, Chan T, Lo W . Tuberculosis infection in Chinese patients undergoing continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 2001; 38(5):1055-60. DOI: 10.1053/ajkd.2001.28599. View

12.

Sarnak M, Jaber B . Pulmonary infectious mortality among patients with end-stage renal disease. Chest. 2001; 120(6):1883-7. DOI: 10.1378/chest.120.6.1883. View

13.

Harel Z, Wald R, McArthur E, Chertow G, Harel S, Gruneir A . Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis. J Am Soc Nephrol. 2015; 26(12):3141-50. PMC: 4657827. DOI: 10.1681/ASN.2014060614. View

14.

Powe N, Jaar B, Furth S, Hermann J, Briggs W . Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int. 1999; 55(3):1081-90. DOI: 10.1046/j.1523-1755.1999.0550031081.x. View

15.

Lovasik B, Zhang R, Hockenberry J, Schrager J, Pastan S, Mohan S . Emergency Department Use and Hospital Admissions Among Patients With End-Stage Renal Disease in the United States. JAMA Intern Med. 2016; 176(10):1563-1565. DOI: 10.1001/jamainternmed.2016.4975. View

16.

Somashekara S, Deepalaxmi S, Jagannath N, Ramesh B, Laveesh M, Govindadas D . Retrospective analysis of antibiotic resistance pattern to urinary pathogens in a Tertiary Care Hospital in South India. J Basic Clin Pharm. 2014; 5(4):105-8. PMC: 4194940. DOI: 10.4103/0976-0105.141948. View

17.

Gupta S, Mallya S, Bhat A, Baliga S . Microbiology of Non-Tunnelled Catheter-Related Infections. J Clin Diagn Res. 2016; 10(7):DC24-8. PMC: 5020248. DOI: 10.7860/JCDR/2016/19058.8155. View

18.

Mohsin B . Pattern Of Causative Micro-Organisms In Catheter Related Blood Stream Infections In Dialysis Patients: Experience From Saudi Arabia. J Ayub Med Coll Abbottabad. 2018; 29(4):635-640. View

19.

Dobler C, McDonald S, Marks G . Risk of tuberculosis in dialysis patients: a nationwide cohort study. PLoS One. 2012; 6(12):e29563. PMC: 3246480. DOI: 10.1371/journal.pone.0029563. View

20.

Berman S, Johnson E, Nakatsu C, Alkan M, Chen R, LeDuc J . Burden of infection in patients with end-stage renal disease requiring long-term dialysis. Clin Infect Dis. 2004; 39(12):1747-53. DOI: 10.1086/424516. View