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Abstract: PO1133

Changes in Sensitivity Patterns of Gram-Negative Isolates in Bacteraemic Haemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Malik, Fatima, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Naito, Anna, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Hurst, Jonathan William, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Stanley, Moira, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Makanjuola, David, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
Background

Gram-negative bacteraemias (GNBs) in haemodialysis (HD) patients are associated with significant morbidity and mortality. While there is a paucity of global data around the quantitative impact of drug resistant organisms, it is clear that they result in increased mortality, longer length of illness and higher costs of delivering appropriate treatment.

We aimed to determine the sensitivity patterns of GNBs in our HD cohort.

Methods

Data were collected from clinical records, electronic records, and the microbiology database of all bacteraemias in HD patients between 2007 and 2018.

Results

283 episodes of GNB occurred in 1361 patients over the 12-year period. Escherichia Coli and Klebsiella Pneumoniae were the dominant pathogens, accounting for 40.6% and 15.9% of bacteraemias isolated respectively.

Sensitivity pattern analysis reveals that Meropenem was almost universally effective against gram negative isolates, with little change over the study period. Similarly, Gentamicin had sensitivity rates of >80% each year except 2010 (50%). Co-Amoxiclav had a variable sensitivity profile and the resistance appeared more prevalent over time – see Figure 1.

Conclusion

Judicious antimicrobial use is a World Health Organisation objective in the fight against antimicrobial resistance. Our local HD policy includes Vancomycin and Gentamicin as empiric therapy. The emergence of Vancomycin-resistant enterococci and more recently staphylococci will influence our future use of Vancomycin. In our population group, Gentamicin therapy remains effective. Carbapenem resistant organisms are a global health threat so whilst Meropenem is efficacious, it should be reserved for more resistant strains or treatment failures. Resistance is increasing at a rate far greater than production of novel antimicrobials so antimicrobial stewardship is paramount; particularly in HD populations with high rates of infection, morbidity and antibiotic exposure.

Figure 1: Sensitivity of gram negative isolates between 2007-2018