Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study

Abstract

BackgroundThere are limited published data on the types and appropriateness of oral and intravenous (IV) antibiotics prescribed to patients receiving haemodialysis. This information is critical to optimise antibiotic prescribing. Therefore this study aims to describe the patterns of use and the appropriateness of oral and IV antibiotics prescribed to patients receiving haemodialysis.MethodsThis was a prospective, observational study across four community and two hospital inpatient haemodialysis units in Melbourne, Australia. Data were collected from July 2014 to January 2015 from participants. Antibiotic regimens prescribed were compared with nationally available antibiotic guidelines and then classified as being either appropriate, inappropriate or not assessable by an expert multidisciplinary team using the National Antimicrobial Prescribing Survey tool.ResultsOverall, 114 participants consented to this study where 55.3% (63/114) received antibiotics and 235 antibiotic regimens were prescribed at a rate of 69.1 antibiotic regimens/100 patient-months. The most common oral antibiotics prescribed were amoxycillin/clavulanic acid and cephalexin. The most common IV antibiotics prescribed were vancomycin, piperacillin/tazobactam, cephazolin and ceftriaxone. The percentage of inappropriate antibiotic regimens prescribed were 34.9% (15/43) in the community setting and 22.1% (40/181) in the hospital setting. Furthermore, 29.4% (30/102) of oral and 20.5% (25/122) of IV antibiotic regimens were inappropriate with incorrect dosing as the primary reason.ConclusionAlthough this study is limited by the sample size, it describes the high antibiotic exposure that patients receiving haemodialysis experience. Of concern is inappropriate dose and frequency being a major issue. This requires interventions focused on the quality use of medicines and antimicrobial stewardship aspects of prescribing in this population.

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“…63% of males developed infections and this finding is similar to other studies such as Katrina Hui et al, Gilbert Abou Dagher et al, and Rojas L et al 11 A number of gram-negative pathogens were detected in cultures and no multi-drug resistant organisms were isolated. In most of the cultures Escherichia coli was the causative organism for infections and this finding coincides with the previously published studies 12,13 . Klebsiella pneumonia was the next commonly detected gramnegative species.…”

The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities

“…9 In dialysis facilities,~30%-35% of antimicrobial doses administered are unnecessary. 10,11 Although antimicrobial stewardship programs have been established for hospital and long-term care settings, 7 programs targeting the unique aspects of outpatient dialysis facilities, where patients receive care at regular intervals, have not been developed. In this study, a multifaceted antimicrobial stewardship program was developed and implemented in 6 outpatient dialysis facilities, and its efficacy in decreasing antimicrobial use was evaluated.…”

Warfarin in nonvalvular atrial fibrillation—Time for a change?

“…24,28,29 Why is anticoagulation quality in HD patients with warfarin worse than that seen in patients with normal kidney function? Some of this could be explained by an increase in the number of comorbid illnesses, increased antibiotic exposure, 30 changes in intestinal flora, reduced vitamin K intake and vitamin K deficiency, 31 polypharmacy with variable adherence 32 and warfarin discontinuation or reversal for procedures.…”