Prevalence and Types of Inappropriate Antibiotics Prescribing Among Dialysis Patients: A Systematic Review

Background/Objectives: Understanding the patterns of inappropriate antibiotic prescribing is crucial to design antimicrobial stewardship interventions. This systematic review evaluated the prevalence and types of inappropriate antibiotic prescribing among dialysis patients. Methods: Four electronic bibliographic databases including PubMed, Embase, Scopus, and CINAHL, were searched. Supplementary search was conducted using Google Scholar and by manually checking the reference list of selected studies. Selected studies include those published in the English language since inception of the databases until October 2024. Two independent reviewers screened, selected, and extracted the data for qualitative synthesis. Results: Of the 784 records identified from the databases, 13 studies fulfilled the eligibility criteria. Eight of the studies (42.6%) were from the USA. Antibiotic prescribing rate ranging from 16 to 75.5% was reported among dialysis patients, with vancomycin (6.5-100%), piperacillin-tazobactam (2.4-44.5%), meropenem (2.1-25.8%), metronidazole (2.1-16.4%), cefazolin (4.3-13.6%), and ceftriaxone (1.3-10.8%) being the most commonly prescribed antibiotics. The studies showed that 20-65.7% of prescriptions are inappropriate, mostly due to inappropriate dosing (25.5-100%), lack of an indication (5.5-73.9%), and inappropriate choice/spectrum (23.6-69.7%). Conclusions: Antibiotic prescribing among dialysis population is higher than the rate reported among hospitalized patients. High rate of broad-spectrum antibiotic prescribing coupled with the high rate of inappropriate antibiotic prescribing indicate the need for the implementation of antimicrobial stewardship programs in dialysis settings.