Treatment of recurrent urinary tract infections in anuric hemodialysis patient, do we really need antimicrobial urinary concentration?

Nekidy, Wasim S. El; Soong, Derrick; Mooty, Mohamad; Ghazi, Islam M.

doi:10.1016/j.idcr.2020.e00748

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…29 A loading dose of ertapenem 1 g IV bolus after HD followed by 0.5 g IV after each subsequent HD session for the 48-hour interdialytic period and 1 g IV for the 72-hour interdialytic period could be considered, especially because this dosing strategy was found to be efficacious in a recent report. 30 This strategy would serve the stewardship perspectives of saving the veins, facilitating hospital discharge (administration in outpatient dialysis units), and reducing the cost on health care systems.…”

Section: Discussionmentioning

confidence: 99%

Ertapenem Neurotoxicity in Hemodialysis Patients—Safe and Effective Dosing Is Still Needed: A Retrospective Study and Literature Review

et al. 2020

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Background: The approved dosing of ertapenem in patients with chronic kidney disease stage 5 utilizing dialysis (CKD-5D) is 0.5 g intravenous daily. Several reports associated this dosing strategy with neurotoxicity. Objective: The purpose of this study is to identify the incidence of neurotoxicity in this population and the risk factors associated with this toxicity. The secondary objective was to review the literature and discuss a safer/cost-effective dosing strategy based on available data. Methods: A retrospective study was conducted screening all patients who received ertapenem and hemodialysis at our quaternary hospital between May 2015 and March 2019. Patients’ demographics, comorbidities, concomitant drugs (known to induce neurotoxicity), and seizure history were collected. Results: A total of 99 eligible patients were identified; 10 of them (10%) developed neurotoxicity. The patients who developed neurotoxicity were all male; mean age was 74 ± 9 years as compared with 68.9 ± 13 years in the sample. Bivariate relationships between all predictors and the seizures (dichotomously coded) were estimated to investigate the risk factors. The following were the significant predictors of seizures: male sex (17%; P = 0.014), dementia (27%; P = 0.012), and concomitant use of β-lactams, aminoglycosides, or fluoroquinolones (19.6%; P = 0.042). Conclusion and Relevance: The currently approved ertapenem dose imposes a risk of developing neurotoxicity in patients with CKD-5D. Utilizing the published data in this population, alternative post-dialysis dosing strategies administered through dialysis access such as 1 g loading dose, followed by either 0.5 g (for the 48 hours interdialytic time) or 1 g (for the 72 hours interdialytic time) might warrant further investigation for efficacy and safety.

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Section: Discussionmentioning

confidence: 99%

Ertapenem Neurotoxicity in Hemodialysis Patients—Safe and Effective Dosing Is Still Needed: A Retrospective Study and Literature Review

et al. 2020

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“…Because of the problems in collecting urine samples from anuric or oliguric HD patients, UTIs are initially difficult to diagnose. Previous evidence suggests that multidrug-resistant bacterial pathogens of UTIs are more common in HD patients compared with those with normal renal function [ 3 ]. Despite extensive studies on UTIs in many countries, little is known about hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Identification of metallo-β-lactamases and AmpC production among Escherichia coli strains isolated from hemodialysis patients with urinary tract infection

et al. 2021

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Background This study aimed to identify metallo-β-lactamases (MBLs) and AmpC β-lactamases-producing Escherichia coli isolates obtained from hemodialysis (HD) patients with urinary tract infections (UTI). Methods and results A total of 257 HD patients with UTI were included in this study, from which 47 E. coli isolates were collected. Antibiotic susceptibility was tested by disc diffusion method. MBLs and AmpC production were phenotypically detected by imipenem-ethylenediaminetetracetate and cefoxitin/boronic acid assays, respectively. The presence of MBLs and AmpC genes was examined by polymerase chain reaction (PCR). Fosfomycin and ampicillin were the most and the least effective antibiotics against E. coli isolates, respectively. Moreover, 61.7% (29/47) of E. coli isolates were multidrug-resistant with seven different antibiotypes. Antibiotype V (AMP–CIP–IMP–MEM–CPD–CRO–CTX–GEN–LEV–SXT–TOB) was the most prevalent profile. Besides, 24 (51.1%) isolates were simultaneously resistant to imipenem and meropenem. Phenotypic assay showed MBL production in 16 (66.7%) of the 24 carbapenem-resistant E. coli isolates. The distribution of MBL genes in carbapenem-resistant E. coli was as follows: bla IMP 18 (72%), bla VIM 7 (28%), and bla NDM 1 (4%). AmpC was detected in 61.7% (29/47) of the isolates using the phenotypic method. The presence of AmpC genes was confirmed by PCR in only 26 of 29 (86.7%) AmpC producers. The frequencies of bla DHA-1 , bla ACC , and bla CMY-2 were 6 (20.7%), 11 (37.9%), and 21 (72.4%), respectively. Conclusions The emergence of MBL and AmpC coproducing E. coli isolates calls for an urgent surveillance program for timely diagnosis and screening of these genes in our healthcare systems.

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“…Trough levels observed with single-dose administration of 1 g following IHD also exceed necessary concentrations for efficacy [ 99 , 100 ]. An additional strategy of a 1 g loading dose following IHD succeeded by 500 mg after subsequent IHD sessions has also been suggested based on a report that utilized this dosing scheme for the treatment of urinary tract infections in anuric patients requiring IHD [ 102 ]. At this time, additional studies evaluating consecutive dosing of both the 500 mg and 1 g post-HD in regard to PK/PD and clinical endpoints are warranted prior to widespread adoption of these alternative dosing strategies.…”

Section: Resultsmentioning

confidence: 99%

Post-Dialysis Parenteral Antimicrobial Therapy in Patients Receiving Intermittent High-Flux Hemodialysis

Cimino

Burnett

Vyas

et al. 2021

Drugs

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Patients with end-stage renal disease (ESRD) requiring intermittent hemodialysis (IHD) are at increased risk of infection, which represents a leading cause of mortality in this population. The use of additional vascular access devices such as peripherally inserted central catheters to treat such infections should be minimized in patients with ESRD requiring IHD in order to mitigate complications such as infection and thrombosis and to maintain venous patency for hemodialysis access. Intravenous antimicrobial dosing following IHD has the advantages of avoiding additional access devices and providing convenience for patients and providers. Vancomycin, cefazolin, and aminoglycosides have historically been regarded as the primary intravenous antimicrobials administered with IHD given their relatively low cost, convenient dosing, and longevity of clinical use. Despite this, a growing body of literature is evaluating the use of an expanded list of antimicrobials that may be employed using post-dialysis dosing for patients requiring IHD; however, the available data are largely limited to pharmacokinetic studies and small cohorts of infected patients or uninfected subjects. Post-dialytic dosing of intravenous antimicrobials may be considered on a patient-by-patient basis after careful consideration of clinical, microbiological, and logistical factors that may influence the probability of treatment success. This document reviews and evaluates currently available information on the post-dialytic administration of an expanded list of intravenous antimicrobials in the setting of thrice-weekly, high-flux IHD.

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Treatment of recurrent urinary tract infections in anuric hemodialysis patient, do we really need antimicrobial urinary concentration?

Cited by 8 publications

References 15 publications

Ertapenem Neurotoxicity in Hemodialysis Patients—Safe and Effective Dosing Is Still Needed: A Retrospective Study and Literature Review

Ertapenem Neurotoxicity in Hemodialysis Patients—Safe and Effective Dosing Is Still Needed: A Retrospective Study and Literature Review

Identification of metallo-β-lactamases and AmpC production among Escherichia coli strains isolated from hemodialysis patients with urinary tract infection

Post-Dialysis Parenteral Antimicrobial Therapy in Patients Receiving Intermittent High-Flux Hemodialysis

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