Courtney K Lawrence1, Chris Sathianathan2, Mauro Verrelli3, Philippe Lagacé-Wiens4, Robert Ariano5, Grace Badejo6, Michelle L Boyce7, J Christine Davis8, Sheryl A Zelenitsky9. 1. , BScPharm, is a PhD student with the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. 2. , MD, FRCPC, is a Nephrologist with the Manitoba Renal Program at St Boniface Hospital, and is also an Assistant Professor with the Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. 3. , BSc, MD, MHA, FRCPC, is a Nephrologist with the Manitoba Renal Program at St Boniface Hospital, and is also an Associate Professor with the Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. 4. , MD, FRCPC, DTM&H, is a Medical Microbiologist with Clinical Microbiology, Diagnostic Services, Shared Health at St Boniface Hospital, and is also an Assistant Professor with the Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. 5. , BScPharm, PharmD, is a Clinical Pharmacist at St Boniface Hospital and is also a Clinical Professor with the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. 6. , HBSc Microbiology, BScPharm, is a Community Pharmacist and Associate at Shoppers Drug Mart, Winnipeg, Manitoba. 7. , BSc, BScPharm, ACPR, is a Hospital Pharmacist at the Ottawa Hospital, Ottawa, Ontario. At the time of this study, she was a candidate for the ACPR designation, which has now been conferred. 8. , BScPharm, PharmD, ACPR, is a Clinical Pharmacist with the Manitoba Renal Program at St Boniface Hospital, and is also a Clinical Assistant Professor with the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. 9. , BScPharm, PharmD, is a Professor in the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, and is also a Nil-Salaried Clinical Pharmacist with the St Boniface Hospital, Winnipeg, Manitoba.
Abstract
BACKGROUND: Given the morbidity and mortality associated with bloodstream infections in hemodialysis patients, understanding the microbiology is essential to optimizing treatment in this high-risk population. OBJECTIVES: To conduct a retrospective surveillance study of clinical blood isolates from adult hemodialysis patients, and to predict the microbiological coverage of empiric therapies for bloodstream infections in this population. METHODS: Clinical blood isolate data were collected from the 4 main outpatient hemodialysis units in Winnipeg, Manitoba, from 2007 to 2014. The distribution of organisms and antimicrobial susceptibilities were characterized. When appropriate, changes over time were tested using time series analysis. Study data were used to predict and compare the microbiological coverage of various empiric therapies for bloodstream infections in hemodialysis patients. RESULTS: The estimated annual number of patients receiving chronic hemodialysis increased steadily over the study period (p < 0.001), whereas the number of blood isolates increased initially, then decreased significantly, from 180 in 2011 to 93 in 2014 (p = 0.04). Gram-positive bacteria represented 72.6% (743/1024) of isolates, including Staphylococcus aureus (36.9%, 378/1024) and coagulase-negative staphylococci (23.1%, 237/1024). Only 26.1% (267/1024) of the isolates were gram-negative bacteria, the majority Enterobacteriaceae. The overall rate of methicillin resistance in S. aureus was 17.5%, and although annual rates were variable, there was a significant increase over time (p = 0.04). Antibiotic resistance in gram-negative bacteria was relatively low, except in Escherichia coli, where 13.5% and 16.2% of isolates were resistant to ceftriaxone and ciprofloxacin, respectively. Empiric therapy with vancomycin plus an agent for gram-negative coverage was predicted to cover 98.8% to 99.7% of blood isolates from hemodialysis patients, whereas cefazolin plus an agent for gram-negative coverage would cover only 67.5% to 68.4%. CONCLUSIONS: In an era of increasing antimicrobial resistance, data such as these and ongoing surveillance are essential components of antimicrobial stewardship in the hemodialysis population. 2020 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
BACKGROUND: Given the morbidity and mortality associated with bloodstream infections in hemodialysis patients, understanding the microbiology is essential to optimizing treatment in this high-risk population. OBJECTIVES: To conduct a retrospective surveillance study of clinical blood isolates from adult hemodialysis patients, and to predict the microbiological coverage of empiric therapies for bloodstream infections in this population. METHODS: Clinical blood isolate data were collected from the 4 main outpatient hemodialysis units in Winnipeg, Manitoba, from 2007 to 2014. The distribution of organisms and antimicrobial susceptibilities were characterized. When appropriate, changes over time were tested using time series analysis. Study data were used to predict and compare the microbiological coverage of various empiric therapies for bloodstream infections in hemodialysis patients. RESULTS: The estimated annual number of patients receiving chronic hemodialysis increased steadily over the study period (p < 0.001), whereas the number of blood isolates increased initially, then decreased significantly, from 180 in 2011 to 93 in 2014 (p = 0.04). Gram-positive bacteria represented 72.6% (743/1024) of isolates, including Staphylococcus aureus (36.9%, 378/1024) and coagulase-negative staphylococci (23.1%, 237/1024). Only 26.1% (267/1024) of the isolates were gram-negative bacteria, the majority Enterobacteriaceae. The overall rate of methicillin resistance in S. aureus was 17.5%, and although annual rates were variable, there was a significant increase over time (p = 0.04). Antibiotic resistance in gram-negative bacteria was relatively low, except in Escherichia coli, where 13.5% and 16.2% of isolates were resistant to ceftriaxone and ciprofloxacin, respectively. Empiric therapy with vancomycin plus an agent for gram-negative coverage was predicted to cover 98.8% to 99.7% of blood isolates from hemodialysis patients, whereas cefazolin plus an agent for gram-negative coverage would cover only 67.5% to 68.4%. CONCLUSIONS: In an era of increasing antimicrobial resistance, data such as these and ongoing surveillance are essential components of antimicrobial stewardship in the hemodialysis population. 2020 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
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