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Antibiogram for haemodialysis catheter-related bloodstream infections
Abdul Halim Abdul Gafor1, Pau Cheong Ping2, Anis Farahanum Zainal Abidin2
1Nephrology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
Insights
Catheter-related bloodstream infections (CRBSIs) in hemodialysis (HD) patients are increasingly caused by gram-negative bacteria. Antibiograms are crucial for selecting effective empirical antibiotic therapy to improve treatment outcomes.
Area of Science:
- Infectious Diseases
- Nephrology
- Clinical Microbiology
Background:
- Catheter-related bloodstream infections (CRBSIs) are a significant complication for patients undergoing long-term hemodialysis (HD).
- Understanding the causative pathogens and their antibiotic susceptibility is vital for effective patient management.
Purpose of the Study:
- To determine the epidemiological characteristics of HD CRBSIs.
- To guide the selection of appropriate empiric antibiotic therapy for patients with HD CRBSIs.
Main Methods:
- Retrospective identification of patients diagnosed with HD CRBSIs.
- Blood cultures analyzed for microbial identification and antibiotic sensitivity testing.
- Data tabulated into antibiograms for analysis.
Main Results:
- 18 patients with HD CRBSIs were identified (median age 61.0 years).
- Gram-negative infections (44.4%) were most common, followed by gram-positive (38.9%) and polymicrobial (16.7%).
- Gram-negative bacteria showed sensitivity to ceftazidime; gram-positive organisms (Coagulase-negative Staphylococcus, Bacillus sp.) were sensitive to vancomycin, but exhibited high cloxacillin resistance.
Conclusions:
- A rising incidence of gram-negative organisms in HD CRBSIs was observed.
- Antibiograms serve as essential tools for empirical antibiotic selection in HD CRBSIs.
- Tailoring antibiotic treatment based on antibiogram data can enhance treatment success and mitigate antibiotic resistance.
Abstract:
Background. Haemodialysis (HD) catheter-related bloodstream infections (CRBSIs) are a major complication of long-term catheter use in HD. This study identified the epidemiology of HD CRBSIs and to aid in the choice of empiric antibiotics therapy given to patients with HD CRBSIs. Methods. Patients with HD CRBSIs were identified. Their blood cultures were performed according to standard sterile technique. Specimens were sent to the microbiology lab for culture and sensitivity testing. Results were tabulated in antibiograms. Results. 18 patients with a median age of 61.0 years (IQR: 51.5-73.25) were confirmed to have HD CRBSIs based on our study criteria. Eight (44.4%) patients had gram-negative infections, 7 (38.9%) patients gram-positive infections, and 3 (16.7%) patients had polymicrobial infections. We noted that most of the gram-negative bacteria were sensitive to ceftazidime. Unfortunately, cloxacillin resistance was high among gram-positive organisms. Coagulase-negative Staphylococcus and Bacillus sp. were the most common gram-positive organisms and they were sensitive to vancomycin. Conclusion. Our study revealed the increased incidence of gram-negative organism in HD CRBSIs. Antibiogram is an important tool in deciding empirical antibiotics for HD CRBSIs. Tailoring your antibiotics accordingly to the antibiogram can increase the chance of successful treatment and prevent the emergence of bacterial resistance.
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