Urinary tract infections in hemodialysis patients-The controversy of antimicrobial drug urine concentrations.

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Tytuł:: Urinary tract infections in hemodialysis patients-The controversy of antimicrobial drug urine concentrations.
Autorzy:: El Nekidy WS; Pharmacy Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Mallat J; Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Nusair AR; Infectious Diseases, Marshall University, Huntington, West Virginia, USA.
Eshbair AH; Pharmacy Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Attallah N; Nephrology Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Mooty M; Infectious Diseases, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Ghosn M; Nephrology Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
Ghazi IM; Pharmacy Practice Department, Arnold and Marie Schwartz College of Pharmacy, Brooklyn, New York, USA.
Źródło:: Hemodialysis international. International Symposium on Home Hemodialysis [Hemodial Int] 2022 Oct; Vol. 26 (4), pp. 548-554. Date of Electronic Publication: 2022 Sep 07.
Typ publikacji:: Journal Article; Observational Study
Język:: English
Imprint Name(s):: Publication: <2003-> : Malden, MA : Blackwell Pub.
Original Publication: Milton, ON : Multimed Inc., c2000-
MeSH Terms:: Anti-Infective Agents*/therapeutic use
Urinary Tract Infections*/diagnosis
Urinary Tract Infections*/drug therapy
Urinary Tract Infections*/etiology
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Renal Dialysis ; Retrospective Studies
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Rault R. Symptomatic urinary tract infections in patients on maintenance hemodialysis. Nephron. 1984;37(2):82-4. https://doi.org/10.1159/000183219.
Keane WF, Shapiro FL, Raij L. Incidence and type of infections occurring in 445 chronic hemodialysis patients. Trans Am Soc Artif Intern Organs. 1977;23:41-7. https://doi.org/10.1097/00002480-197700230-00012.
Gilbert DN. Urinary tract infections in patients with chronic renal insufficiency. Clin J Am Soc Nephrol. 2006;1(2):327-31. https://doi.org/10.2215/CJN.01931105.
el Nekidy WS, Soong D, Mooty M, Ghazi IM. Treatment of recurrent urinary tract infections in anuric hemodialysis patient, do we really need antimicrobial urinary concentration? IDCases. 2020;21(20):e00748. https://doi.org/10.1016/j.idcr.2020.e00748.
Sobel JD, Kaye D. Urinary tract infections. In: Mandell GL, Bennett JE, editors. Principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier Saunders; 2014. p. 886-913.
Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-63. https://doi.org/10.1086/650482.
Stamey TA, Fair WR, Timothy MM, Millar MA, Mihara G, Lowery YC. Serum versus urinary antimicrobial concentrations in cure of urinary-tract infections. N Engl J Med. 1974;291(22):1159-63. https://doi.org/10.1056/NEJM197411282912204.
White CR, Jodlowski TZ, Atkins DT, Holland NG. Successful doxycycline therapy in a patient with Escherichia coli and multidrug-resistant Klebsiella pneumoniae urinary tract infection. J Pharm Pract. 2017;30(4):464-7. https://doi.org/10.1177/0897190016642362.
el Nekidy WS, Soong D, Kadri A, Tabbara O, Ibrahim A, Ghazi IM. Salvage of hemodialysis catheter in staphylococcal bacteremia: case series, revisiting the literature, and the role of the pharmacist. Case Rep Nephrol Dial. 2018;8(2):121-9. https://doi.org/10.1159/000489923.
Mouton JW, Theuretzbacher U, Craig WA, Tulkens PM, Derendorf H, Cars O. Tissue concentrations: do we ever learn? J Antimicrob Chemother. 2008;61(2):235-7. https://doi.org/10.1093/jac/dkm476.
Contributed Indexing:: Keywords: dialysis; drug concentration; efficacy; urinary tract infections
Substance Nomenclature:: 0 (Anti-Bacterial Agents)
0 (Anti-Infective Agents)
Entry Date(s):: Date Created: 20220907 Date Completed: 20221005 Latest Revision: 20221029
Update Code:: 20240105
DOI:: 10.1111/hdi.13041
PMID:: 36071534
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Background: Major infectious diseases societies recommend the use of antimicrobials that achieve high-urinary concentrations to treat urinary tract infection (UTI), which is a concept of little relevance to the oliguric and anuric hemodialysis (HD) dependent population. Outcome studies in this population are more relevant, but unfortunately scarce. We sought to investigate the impact of different antimicrobials on clinical and microbiologic outcomes in HD dependent population.
Methods: A retrospective observational study conducted at our quaternary care hospital between May 2015 and December 2019. We included all HD dependent adults diagnosed with UTIs. Our primary end points were clinical and microbiologic cure. Our secondary end points were 90-day recurrence and mortality.
Results: Fifty-six patients were included in the study with 33 (58.9%) females, mean age of 69.9 ± 11.6 years, and mean body mass index of 27.7 ± 7.8 kg/m 2 . Thirty-six subjects of the sample (64.3%) were anuric. Ninety-one percent of the patients achieved clinical cure. Out of those who had repeat cultures, 90.7% achieved microbiologic cure. Clinical and microbiologic cure rates were not significantly different between the oliguric and anuric groups. The 90-day recurrence rate was 11.1% and mortality was 19%, none of them was related to UTI.
Conclusion: Our findings demonstrate high rate of clinical and microbiologic cure in the treatment of oliguric and anuric HD dependent patients. We suggest that drug development and treatment societies to consider clinical and microbiologic outcomes in conjunction with achievable urinary concentration when making recommendations for the treatment of UTI.
(© 2022 International Society for Hemodialysis.)

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