The Epidemiology of Multidrug-Resistant Sepsis among Chronic Hemodialysis Patients

Abstract

Sepsis is one of the leading causes of hospitalization and death among hemodialysis patients. Infections due to multidrug-resistant organisms (MDROs) are common among these patients, but empiric broad-spectrum coverage for every septic patient is associated with unfavorable outcomes. A retrospective case–control study was conducted at Shamir Medical Center, Israel (July 2016–April 2020), to determine predictors of MDRO infections among septic (per SEPSIS-3) ambulatory adult hemodialysis patients with permanent dialysis access (i.e., fistula, graft, or tunneled Perm-A-Cath). MDROs were determined according to established definitions. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to construct a prediction score and determine its performance. Of 509 patients, 225 (44%) had microbiologically confirmed infection, and 79 patients (35% of 225) had MDROs. The eventual independent predictors of MDRO infections were Perm-A-Cath access (vs. fistula or graft, aOR = 3, CI-95% = 2.1–4.2) and recent hospitalization in the previous three months (aOR = 2.3, CI-95% = 1.6–3.3). The score to predict MDRO sepsis with the highest performances contained seven parameters and displayed an area under the receiver operating characteristic curve (ROC AUC) of 0.74. This study could aid in defining a group of hemodialysis patients for which empiric broad-spectrum agents could be safely avoided.

A biomarker panel of C-reactive protein, procalcitonin and serum amyloid A is a predictor of sepsis in severe trauma patients: a case control study

“…Sepsis may induce fatal organ failures due to the loss of control of the infection, thereby leading to septic shock. There are 31,500,000 cases of sepsis every year worldwide, with 5,300,000 death and 17% mortality rate[6], and it costs 170 billions dollars annually to treat the sepsis patients [7]. Therefore, it has become one of the most vital issues to lower the occurrence and mortality of sepsis in the eld of critical medicine.…”

Management of Patients with Multidrug-Resistant Organisms in Outpatient Dialysis Facilities

“…1,2 Management of patients with MDRO may necessitate altering patient and staff scheduling, limiting or eliminating the use of shared equipment and space, and at times even closure or suspension of new admissions. 2,12 These additional precautions are costly and impose additional staff demands, further exacerbating unprecedented labor shortages, supply cost inflation, and caregiver burnout. Unlike acute care settings, it is not possible to provide one-on-one nursing for these patients in an outpatient setting.…”