Factors associated with the receipt of antimicrobials among chronic hemodialysis patients

Abstract

Background Antimicrobial use is common among patients receiving chronic hemodialysis (CHD) and may represent an important antimicrobial stewardship opportunity. The objective of this study is to characterize CHD patients at increased risk of receiving antimicrobials, including not indicated antimicrobials. Methods We conducted a prospective cohort study over a 12-month period among patients receiving CHD in 2 outpatient dialysis units. Each parenteral antimicrobial dose administered was characterized as indicated or not indicated based on national guidelines. Patient factors associated with receipt of antimicrobials and receipt of ≥1 inappropriate antimicrobial dose were analyzed. Results A total of 89 of 278 CHD patients (32%) received ≥1 antimicrobial doses and 52 (58%) received ≥1 inappropriately indicated dose. Patients with tunneled catheter access, a history of colonization or infection with a multidrug-resistant organism, and receiving CHD sessions during daytime shifts were more likely to receive antimicrobials (odds ratio [OR], 5.16; 95% confidence interval [CI], 2.72–9.80; OR, 5.43; 95% CI, 1.84–16.06; OR, 4.59; 95% CI, 1.20–17.52, respectively). Patients with tunneled catheter access, receiving CHD at dialysis unit B, and with a longer duration of CHD prior to enrollment were at higher risk of receiving an inappropriately indicated antimicrobial dose (incidence rate ratio, 2.23; 95% CI, 1.16–4.29; incidence rate ratio, 2.67; 95% CI, 1.34–5.35; incidence rate ratio, 1.11; 95% CI, 1.01–1.23, respectively). Conclusions This study of all types of antimicrobials administered in 2 outpatient dialysis units identified several important factors to consider when developing antimicrobial stewardship programs in this health care setting.

Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy

“…While this is an association that does not imply causality, the robust observation of poor outcomes in this vulnerable patient population and the quantification of this effect add to the existing literature of impact of infections on patients with chronic renal failure. Furthermore, these findings add to existing studies to emphasize the clear need for infection control measures and antibiotic stewardship in patients on RRT [ 28 ].…”

Prevalence of infections and antimicrobial use among hemodialysis outpatients: A prospective multicenter study

“…Notably, approximately 70% of oral antimicrobial use was self‐medication in this population, which might markedly increase the possibility of inappropriate use. A prospective study also documented that high frequency and inappropriate prescription of antimicrobial use were received in chronic hemodialysis patients . This could contribute to the acquisition of multidrug‐resistant organism (MDRO) colonization or infection among hemodialysis patients.…”

“…A prospective study also documented that high frequency and inappropriate prescription of antimicrobial use were received in chronic hemodialysis patients. 28 This could contribute to the acquisition of multidrug-resistant organism (MDRO) colonization or infection among hemodialysis patients.…”

Quantifying Antimicrobial Exposure: Hazards in Populations With End-Stage Renal Disease

“…Findings from this study pertaining to antimicrobial utilization rates and appropriateness of indication have been previously published. 5,6 This study was approved by the institutional review board at the investigators’ and study site institutions.…”