Abstract
BackgroundMultidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. At the same time, colonization and consecutive infections with such pathogens may increase mortality and morbidity of affected individuals. We aimed to monitor intestinal MDRGN colonization in a yet not investigated German HD population.MethodsWe performed cross-sectional point-prevalence testing with 12 months follow-up and selected testing of relatives in an out-patient HD cohort of n = 77 patients by using microbiological cultures from fresh stool samples, combined with Matrix Assisted Laser Desorption Ionization—Time of Flight Mass Spectrometry (MALDI-TOF-MS) and antimicrobial susceptibility testing.ResultsWe detected MDRGN in 8 out of 77 patients (10.4%) and 1 out of 22 relatives (4.5%), indicating only colonization and no infections. At follow-up, 2 patients showed phenotypic persistence of MDRGN colonization, and in 6 other patients de-novo MDRGN colonization could be demonstrated. Pathogens included Escherichia coli and Klebsiella pneumoniae (with extended-spectrum beta-lactamase [ESBL]-production as well as fluoroquinolone resistance), Stenotrophomonas maltophilia and Enterobacter cloacae.ConclusionsIn a single-center study, MDRGN colonization rates were below those found in non-HD high-risk populations and HD units in the US, respectively. Reasons for this could be high hygiene standards and a strict antibiotic stewardship policy with evidence of low consumption of fluoroquinolones and carbapenems in our HD unit and the affiliated hospital.
Highlights
Infections with antibiotic-resistant bacteria are a striking problem in patients with chronic diseases and compromised immune status
Colonization with Multidrug-resistant Gram-negative bacteria (MDRGN) in a German hospital-affiliated hemodialysis center received research speaker or consultation honoraria related to other projects from FMC and Alexion
In a single-center study, MDRGN colonization rates were below those found in non-HD high-risk populations and HD units in the US, respectively
Summary
Infections with antibiotic-resistant bacteria are a striking problem in patients with chronic diseases and compromised immune status. Other concerns have been raised in terms of spreading multidrug-resistant Gram-negative bacteria (MDRGN) among non-HD chronic-disease patient populations [1, 5, 6] since these pathogens are associated with up to five times higher mortality rates compared with susceptible Gram-negative bacteria regarding blood stream infections [7, 8]. In a British HD center from 2011 to 2014, 84 patients experienced 95 Gram-negative infections [19] Despite these trends, antimicrobial resistance among Gram-negative bacteria has not been previously investigated in chronic HD patients in Europe or Germany. Multidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. We aimed to monitor intestinal MDRGN colonization in a yet not investigated German HD population
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