L PARVARESH¹, S C-A CHEN, V W LEE³´⁴, V SINTCHENKO¹´²´⁴
¹Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Westmead, NSW; ²Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, NSW Health Pathology, Westmead Hospital, NSW; ³Department of Renal Medicine, Westmead Hospital, Westmead, NSW; ⁴Sydney Medical School, The University of Sydney, NSW
Aim: This review of episodes of bacteraemia in haemodialysis patients, admitted to a tertiary hospital in Sydney and dialysed through any type of vascular access, was conducted in order to determine the frequency and patterns of antimicrobial resistance or causative organisms.
Background: Bacteraemia is the most common infection-related cause of mortality in patients with kidney disease on haemodialysis. Staphylococcus aureus, coagulase negative staphylococci (CONS), Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., and Enterobacter spp. are the most frequent isolates. Antibiotic use in patients on haemodialysis are also considered a substantial contributor to the emergence of antibacterial-resistance.
The World Health Organisation (WHO) global action plan for reducing antimicrobial-resistance identified surveillance for antimicrobial-resistance and optimising antimicrobial agents’ use as one of its main objectives. It aims at ensuring effective anti-microbial stewardship for optimal treatment.
Methods: Our population was chronic haemodialysis patients with access related bacteraemia (ARB) during 2015-2016.The relevant data was collected from electronic medical records at Westmead Hospital and the Centre for Infectious Diseases and Microbiology Laboratory Services. Descriptive statistics were used to analyse the data.
Results: From 506 dialysis patients, 22 were diagnosed with ARB, with 25 positive cultures. 9(32%) of these cultures, grow Methicillin Sensitive Staphylococcus aureus followed by 6(21%) Methicillin Resistant Staphylococcus aureus (MRSA). 39% of our gram-positive (MRSA-21%, CONS-14%, VRE-4%) and 4% of our gram-negative (Klebsiella pneumonia-4%) organisms were penicillin-resistant.
Conclusion: Most of episodes of bacteraemia were caused by gram-positive organisms. 43% of our reported isolates were resistant to penicillin and first generation cephalosporins, in-vitro. These findings emphasise the necessity of using more broad-spectrum antibiotics for empirically treating access related bacteraemia in our population.