Risk factors for Multi-Drug Resistance in Culturable Bacteria Isolated in End-stage Renal Disease Patients Receiving Dialysis: Cohort Study in One Large Tertiary Hospital in England

Abstract

Background Bacterial infections are one of the leading causes of death among patients receiving chronic dialysis. The risk of infections with multi-drug-resistant (MDR) organisms is high among patients receiving dialysis. Multi-drug resistant infections have reduced efficacy of antibiotics, prolonged infection duration, and increased mortality and morbidity. Evidence on the risk factors for infection with MDR organisms among patients on dialysis is limited and not fully explored. Therefore, the main aim of this study is to identify the incidence and risk factors for multi-drug resistant (MDR) organisms among end-stage renal disease patients receiving dialysis in England.

Methods A retrospective observational study of 5,227 adult patients with end-stage renal disease receiving dialysis in the Queen Elizabeth Hospital Birmingham (QEHB) renal services between January 1, 2019 and December 30, 2020. Risk factors for the development of multi-drug resistant (MDR) isolates were assessed using multi-level uni-variable and multi-variable logistic regression models.

Results During the study period, an MDR bacterial organism was isolated in 2.8% (95% CI 2.4-3.3) of cohort patients, with an incidence rate of 14.1 (95% CI 12-16.5) per 1000 person-years. A total of 2029 bacterial isolates were identified with 427 (21.5%) MDR isolates and 1592 (78.5%) non-MDR isolates. The risk of MDR isolate was significantly associated with the presence of liver disease diagnosis (OR 5.62, 95% CI 1.16-27.16), number of hospitalizations in the previous 12 months (OR for ≥4 versus 0: 2.21, 95% CI 1.06-4.59), and the cumulative DDD of antibiotics in the previous 6 months (OR 1.010, 95% CI 1.001-1.019).

Conclusion This study demonstrated that the presence of a liver disease diagnosis, the number of hospitalization in the previous 12 months, and antibiotic exposure in the previous six months are significant risk factors for the development of MDR bacterial isolates among patients with end-stage renal disease receiving dialysis. These results will help guide future studies and interventions to assess and improve the overall practice of antibiotics prescribing for this population.