SPECTRUM OF INFECTIONS AND ASSESSMENT OF ANTIBIOTIC USE IN MAINTENANCE HEMODIALYSIS PATIENTS

Indian literature relating to the spectrum of infections in maintenance hemodialysis patients has not been extensively published. The purpose of this study was to carry out surveillance of infections in this population and to determine the clinical patterns and outcomes of infections and also to assess the prescribed antibiotic therapy. This was a prospective observational study carried out in the dialysis unit of the nephrology department of a tertiary care teaching hospital. The sample of the study comprised of 30 patients who were receiving maintenance hemodialysis and presented with infections. Escherichia coli was the commonly detected gram-negative pathogen in culture and sensitivity tests. Whereas the most commonly isolated gram-positive bacteria were streptococcus pneumonia and methicillin-resistant staphylococcus species which were sensitive to vancomycin. Respiratory system (47.2%) followed by the urinary system (27.3%) were most commonly affected. The most common outcome of infections was a cure (57%). Clarithro-mycin and ofloxacin-ornidazole were found to be inappropriately dose adjusted. Amoxicillin-clavulanate, cefixime, ticarcillin-clavulanic acid, levofloxacin, piperacillin-tazobactam, mero-penem and imipenem-cilastatin were inappropriately adjusted for dosing frequency. This study reveals that the prevalence of infections is quite high in tertiary care hospitals despite safe practices. Antimicrobial stewardship or continuing education related interventions are needed to optimize the safe and appropriate use of antibiotics.