The relationship between renal functions and multi-drug resistant organisms in patients with ventilator-associated pneumonia

Year 2023, Volume: 36 Issue: 1, 52 - 58, 31.01.2023

Omur Ilban Aysegul Ilban

https://doi.org/10.5472/marumj.1244732

Cited By: 1

Abstract

Objective: Despite the increase in the frequency of multi-drug resistant organism (MDRO) colonisation and infection in dialysis
patients, it is not well known whether the risk of multi-drug resistant (MDR) pneumonia increases in mild-to-severe chronic kidney
disease patients not undergoing dialysis. Therefore, we aimed to evaluate the relationship between renal functions and the risk of MDR
ventilator-associated pneumonia (VAP) and the specific microbial pattern.
Patients and Methods: A total of 133 patients who developed VAP were divided according to their renal function into two groups, an
estimated glomerular filtration rate of (eGFR) ≥ 60 mL/ min/1.73 m2 (high eGFR, n=65) and eGFR < 60 mL/min/1.73 m2 (low eGFR,
n=68).
Results: The low eGFR group presented a significantly high MDRO ratio (p<0.01). With the decrease in eGFR, the frequency of grampositive
MDRO did not change (p=0.63), while the increase in gram-negative MDRO was statistically significant (p<0.01). Low eGFR
was found to be an independent predictor for antimicrobial resistance. (Odds ratio, (OR): 2.821).
Conclusion: Among VAP patients, chronic renal failure is associated with increased MDRO infection. The eGFR may be used to
identify mechanically ventilated patients with a high risk of MDR pneumonia.

Keywords

Chronic kidney disease, Glomerular filtration rate, Multiple drug resistance, Risk factors, Ventilator-associated pneumonia

References

• Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-44. doi:10.1001/jama.1995.035.30080055041.
• Holmes AH, Moore LSP, Sundsfjord A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 2016;387:176-87. doi: 10.1016/S0140-6736(15)00473- 0.
• Xu H, Gasparini A, Ishigami J, et al. eGFR and the risk of community-acquired infections. Clin J Am Soc Nephrol 2017;12:1399-408. doi: 10.2215/CJN.00250117.
• The Lancet Infectious Diseases. Antibiotic resistance: long-term solutions require action now. Lancet Infect Dis 2013;13:995. doi: 10.1016/S1473-3099(13)70290-1.
• McDonald HI, Thomas SL, Nitsch D. Chronic kidney disease as a risk factor for acute community-acquired infections in high-income countries: a systematic review. BMJ Open 2014;4:e004100. doi: 10.1136/bmjopen-2013-004100.
• Calfee DP. Multidrug-resistant organisms within the dialysis population: a potentially preventable perfect storm. Am J Kidney Dis 2015;65:3-5. doi: 10.1053/j.ajkd.2014.10.003.
• McDonald HI, Nitsch D, Millett ERC, Sinclair A, Thomas SL. Are pre-existing markers of chronic kidney disease associated with short-term mortality following acute communityacquired pneumonia and sepsis? A cohort study among older people with diabetes using electronic health records. Nephrol Dial Transplant 2015;30:1002-9. doi: 10.1093/ndt/gfu401.
• Zacharioudakis IM, Zervou FN, Ziakas PD, Rice LB, Mylonakis E. Vancomycin-resistant Enterococci colonization among dialysis patients: A meta-analysis of prevalence, risk factors, and significance. Am J Kidney Dis 2015;65:88-97. doi: 10.1053/j.ajkd.2014.05.016.
• American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416. doi: 10.1164/rccm.200405-644ST.
• Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 2003;31:676-82. doi: 10.1097/01.CCM.000.005.5380.86458.1E.
• Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-12. doi: 10.7326/0003-4819-150-9- 200905.050.00006.
• Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. doi: 10.1016/0021-9681(87)90171-8.
• Salluh JI, Soares M. ICU severity of illness scores: APACHE, SAPS and MPM. Curr Opin Crit Care. 2014;20:557-65. doi: 10.1097/MCC.000.000.0000000135.
• Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrugresistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81. doi: 10.1111/j.1469-0691.2011.03570.x.
• Ferrer M, Difrancesco LF, Liapikou A, et al. Polymicrobial intensive care unit-acquired pneumonia: prevalence, microbiology and outcome. Crit Care 2015;19:450. doi: 10.1186/s13054.015.1165-5.
• Porzecanski I, Bowton DL. Diagnosis and treatment of ventilator‑associated pneumonia. Chest 2006;130:597‑604. doi: 10.1378/chest.130.2.597.
• European Committee on Antimicrobial Susceptibility Testing. European Society of Clinical Microbiology and Infectious Diseases. Clinical Breakpoints. EUCAST 2019.
• Hosmer DW, Lemeshow S. Goodness of fit tests for the multiple logistic regression model. Commun Stat–Theor M 1980;9:1043-69. doi: 10.1080/036.109.28008827941.
• Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-35. doi: 10.1002/1097-0142(1950)3:1<32::aidcncr282.003.0106> 3.0.co;2-3
• Grandfils N, Detournay B, Attali C, et al. Glucose lowering therapeutic strategies for type 2 diabetic patients with chronic kidney disease in primary care setting in france: a crosssectional study. Int J Endocrinol 2013;2013:640632. doi: 10.1155/2013/640632.
• Zacharioudakis IM, Zervou FN, Ziakas PD, Mylonakis E. Meta-analysis of methicillin-resistant Staphylococcus aureus colonization and risk of ınfection in dialysis patients. J Am Soc Nephrol 2014;25:2131-41. doi: 10.1681/ASN.201.309.1028.
• Chih-Chao Y, Chien-Hsing W, Chien-Te L, et al. Nosocomial extended-spectrum betalactamase-producing Klebsiella pneumoniae bacteremia in hemodialysis patients and the implications for antibiotic therapy. Int J Infect Dis 2014;28:3- 7. doi: 10.1016/j.ijid.2014.07.012.
• Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of ınfection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med 2008;168:2205-10. doi: 10.1001/archinte.168.20.2205.
• Su G, Xu H, Riggi E, et al. Association of kidney function with ınfections by multidrug-resistant organisms: an electronic medical record analysis. Sci Rep 2018;8:13372. doi: 10.1038/ s41598.018.31612-1.
• Pop-Vicas A, Strom J, Stanley K, D’Agata EMC. Multidrugresistant gram-negative bacteria among patients who require chronic hemodialysis. Clin J Am Soc Nephrol 2008;3:752-8. doi: 10.2215/CJN.04651107.
• Jamil B, Mukhtar Bokhari MT, Saeed A, et al. Multidrug resistance in Gram negative pathogens isolated from patients with chronic kidney diseases and renal transplant. J Pak Med Assoc 2018;68:642-5.
• Ren J, Li X, Wang L, et al. Risk factors and drug resistance of the MDR Acinetobacter Baumannii in pneumonia patients in ICU. Open Med 2019;14:772-777. doi: 10.1515/med-2019- 0090.
• Ewig S, Welte T, Chastre J, Torres A. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis 2010;10:279-87. doi: 10.1016/ S1473-3099(10)70032-3.
• Micek ST, Wunderink RG, Kollef MH, et al. An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistance. Crit Care 2015;19:219. doi: 10.1186/s13054.015.0926-5.
• Leal HF, Azevedo J, Silva GEO, et al. Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features. BMC Infect Dis 2019;19:609. doi: 10.1186/s12879.019.4265-z.
• Kalam K, Qamar F, Kumar S, Ali S, Baqi S. Risk factors for carbapenem resistant bacteraemia and mortality due to gram negative bacteraemia in a developing country. J Pak Med Assoc 2014;64:530-6.
• Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Management and prevention of ventilator-associated pneumonia caused by multidrug-resistant pathogens. Expert Rev Respir Med 2012;6:533-55. doi: 10.1586/ers.12.45.
• Al-Jaghbeer M, Dealmeida D, Bilderback A, Ambrosino R, Kellum JA. Clinical decision support for in-hospital AKI. J Am Soc Nephrol 2018;29:654-60. doi: 10.1681/ASN.201.707.0765.
• Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015;41:1411-23. doi: 10.1007/s00134.015.3934-7.
• Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet 2019;394:1949-1964. doi: 10.1016/S0140-6736(19)32563-2.
• Katona P, Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis 2008;46:1582-8. doi: 10.1086/587658.
• Young P, Lombi F, Finn BC, et al. “Malnutrition‐inflammation complex syndrome” in chronic hemodialysis. Medicina 2011;71:66-72.
• James MT, Quan H, Tonelli M, et al. CKD and risk of hospitalization and death with pneumonia. Am J Kidney Dis 2009;54:24-32. doi: 10.1053/j.ajkd.2009.04.005.
• Kafri MW, Potter JF, Myint PK. Body composition changes in acute stroke by type of feeding regimen. Int J Clin Pract 2016;70:175-7. doi: 10.1111/ijcp.12759.