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The Epidemiology of Multidrug-Resistant Sepsis among Chronic Hemodialysis Patients

Shani Zilberman-Itskovich1,2, Yazid Elukbi3, Roni Weinberg Sibony4

  • 1Tel-Aviv Medical Center (Sourasky), Tel-Aviv 6423906, Israel.

Antibiotics (Basel, Switzerland)
|September 23, 2022
PubMed

Insights

Predicting multidrug-resistant organism (MDRO) sepsis in hemodialysis patients is crucial. Central venous catheter (Perm-A-Cath) use and recent hospitalization independently predict MDRO infections, aiding targeted antibiotic strategies.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Sepsis is a major cause of mortality in hemodialysis patients.
  • Multidrug-resistant organism (MDRO) infections are prevalent in this population.
  • Empiric broad-spectrum antibiotics in sepsis can lead to adverse outcomes.

Purpose of the Study:

  • To identify predictors of MDRO infections in septic hemodialysis patients.
  • To develop a predictive score for MDRO sepsis in this cohort.
  • To guide judicious use of broad-spectrum antibiotics.

Main Methods:

  • Retrospective case-control study (July 2016-April 2020).
  • Inclusion of ambulatory adult hemodialysis patients with permanent access (fistula, graft, Perm-A-Cath).
  • Least Absolute Shrinkage and Selection Operator (LASSO) regression for predictor identification and score development.

Main Results:

  • Of 509 patients, 225 (44%) had confirmed infections, with 79 (35%) being MDROs.
  • Independent predictors of MDRO infections: Perm-A-Cath access (aOR=3) and recent hospitalization (aOR=2.3).
  • A 7-parameter prediction score achieved an ROC AUC of 0.74.

Conclusions:

  • Perm-A-Cath use and recent hospitalization are key predictors of MDRO sepsis in hemodialysis patients.
  • A validated prediction score can help identify patients at high risk for MDRO infections.
  • This tool may enable de-escalation of empiric broad-spectrum antibiotics in select patients.
Keywords:
MDROantimicrobial resistancedialysishemodialysissepsis

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