April 1, 2021

Analysis seeks to better manage infection in dialysis patients

Analysis seeks to better manage infection in dialysis patients


by Emily Stembridge

In a study published by the medical journal Drugs, Christo Cimino, PharmD, BCPS, BCIDP, set out to compare alternative antimicrobial therapies for patients with end-stage renal disease (ESRD) receiving high-flux hemodialysis.

Patients with ESRD receiving dialysis are at an increased risk of infection — partly due to their frequent presence at health care institutions, where they are exposed to many other patients. This, coupled with possible comorbidities, means dialysis patients’ risk for infection is approximately 100-fold higher than the general population.

One common infection is methicillin-resistant staphylococcus aureus, or MRSA, which has up to a 30% mortality rate in infected dialysis patients. These patients are typically administered intravenous (IV) antibiotics following their dialysis treatment to manage infection complications. Other advantages to IV dosing at dialysis include convenience, guaranteed adherence and most importantly, the avoidance of placing additional catheters near the heart.

“Our goal was to evaluate IV antibiotics we could give at a dialysis center,” Cimino said. “Historically, there have only been a few different antibiotics used extensively in that setting. This review was to look at options that don’t require adding additional vascular access lines, which may compromise important veins used for dialysis.”

Cimino and the research team examined 11 in total, creating a chart with drug-specific notes from the research. Their goal was to create a reference tool of alternatives for medical professionals to consider, ultimately benefitting patients who may have bacterial resistance to or an allergy to commonly used antibiotics.

“We found that some of our alternative antibiotics can be safely administered on a case-by-case basis, after considering all external factors for the patient,” Cimino said. “It’s important that we still remain cognizant of clinical and microbiological factors before we administer these doses.”

Determining who is a good fit for an alternative antibiotic will require the insight of a wide range of care providers, including clinical pharmacists, nephrologists, dialysis nurses and infectious disease providers. Together, these experts can determine what bacteria is causing a patient’s infection, decide on alternative options, get the antibiotics paid for and administer the antibiotics to the patient.

There have been major developments in dialysis therapy over the last 20 years, with improved outcomes and more personalized treatment plans for patients. Cimino says expanding options for IV antimicrobials is the next step. “I hope the research provides patients with more options, and potentially better options, than what the standard has been in the past,” he said.