Abstract: PUB382
Empiric Antibiotics and Infection Trends in CKD: Insights from the COVID-19 and Post-COVID-19 Era
Session Information
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Antonakis, Andreas, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Mitrakos, Marinos Irinaios, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Drosataki, Eleni, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Dermitzaki, Eleftheria-Kleio, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Lygerou, Dimitra, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Konidaki, Myrto, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Papadakis, Nikolaos, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Pleros, Christos, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Androvitsanea, Ariadni, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Kavvadias, Georgios-Alexandros, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Kydonaki, Konstantina, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Stylianou, Konstantinos, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
- Petrakis, Ioannis, Department of Nephrology, Heraklion University Hospital, Heraklion, Crete, Greece
Background
Patients with chronic(CKD) or acute kidney disease(AKD), renal transplants(KTx), or on hemodialysis(HD) are vulnerable to infections. Empiric antibiotic therapy often deviates from pathogen susceptibility. The COVID-19 period may have shifted resistance dynamics, underscoring the need for contemporary data to guide empiric treatment. We explore this in a CKD cohort from Heraklion University Hospital, Greece.
Methods
Patient records were evaluated for mortality, empiric antibiotic therapies, microbiological resistance, length of stay, and admissions from 2020 to 2024. Fourier analysis(FFT) was performed to control for COVID-19, and post-COVID-19 era admission patterns. Multinomial Logistic Regression analyses, Test Chi-Square, and ANOVA statistical models were employed using custom R and Python scripts. The study was approved by our institution's ethics committee(40871/07.02.25)
Results
We investigated 1739(503HD, 259AKD, 913CKD, 64KTx) patients. Infection during/post-COVID altered FFT-cycle volume of events and their cadence(p<0.001). Only AKD was linked to mortality and positive cultures(ANOVA,p<0.01) post-COVID. UTI was highest in CKD(35.7%) and AKD(32.6%), RTI in KTx(11.7%). Only HD showed no link between suspected and confirmed infection site(p=0.87). Resistance rates varied by class(p<0.01). In logistic regression: CKD had lower resistance odds(OR=0.47, p<0.01) vs. HD; AKD trended higher(OR=1.36, p=0.050); KTx was not significant(p=0.267). Multi-Drug Resistant(MDR) rates varied by period(Chi.sq=13.06, p<0.01), highest during COVID(9.2%). Logistic regression showed that only antibiotic count was significant(OR=1.10, p<0.01); each additional antibiotic raised MDR odds by ~10%. The COVID period itself had no independent effect.
Conclusion
The post-COVID era altered hospital stay and readmission rhythms. In HD patients, suspected vs. confirmed infection sites misalign, complicating diagnosis. Resistance differed across CKD classes; HD and KTx bear the highest burden. Multivariable analysis showed that antibiotic burden, not COVID period, was the primary driver of MDR risk, with each additional antibiotic increasing MDR odds by~10 %.