Association of Kidney Function with Infections by Multidrug-Resistant Organisms: An Electronic Medical Record Analysis.

ABSTRACT: Antibiotic resistance is a major global health threat. High prevalences of colonization and infection with multi-drug resistance organisms (MDROs) have been reported in patients undergoing dialysis. It is unknown if this finding extends to patients with mild and moderate/severe kidney disease. An observational study included all adult incident patients hospitalized with a discharge diagnosis of infection in four hospitals from Guangzhou, China.

Inclusion criteria

Serum creatinine measurement at admission together with microbial culture confirmed infections. Exclusion criterion: Undergoing renal replacement therapy. Four categories of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) were compared: eGFR???105, 60-104 (reference), 30-59, and <30?ml/min/1.73?m². The odds ratio of MDROs, defined as specific pathogens (Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp.) resistant to three or more antibiotic classes, were calculated using a multivariable logistic regression model across eGFR strata. Of 94,445 total microbial culture records, 7,288 first positive cultures matched to infection diagnosis were selected. Among them, 5,028 (68.9%) were potential MDROs. The odds of infections by MDROs was 19% and 41% higher in those with eGFR between 30-59?ml/min/1.73?m² (Adjusted odds ratio, AOR): 1.19, 95% CI:1.02-1.38, P?=?0.022) and eGFR?2 (AOR: 1.41, 95% CI:1.12-1.78, P?=?0.004), respectively. Patients with impaired renal function have a higher risk of infections by MDROs. Kidney dysfunction at admission may be an indicator for need of closer attention to microbial culture results requiring subsequent change of antibiotics.

SUBMITTER: Su G 

PROVIDER: S-EPMC6127257 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature