Empiric antimicrobial use in the treatment of dialysis related infections in RIPAS Hospital.
Lah Kheng CHUA, Department of Pharmacy, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
ABSTRACT
Introduction: Haemodialysis catheter related infection has emerged as one of the many serious complications and remains a significant cause of morbidity and mortality. Patients who are immunocompromised and have history of bacteraemia are particularly at risk of getting catheter-related infection. The aim of this study is to assess the use of antimicrobial in the empirical treatment of continued ambulatory peritoneal dialysis (CAPD) peritonitis and dialysis line related infections in haemodialysis patients using the local published guidelines as the standard measure. Materials and Methods: Female patients undergoing renal replacement therapies who were admitted for CAPD peritonitis and dialysis line related infections in RIPAS Hospital between 15th March 2010 and 15th September 2010 were the subjects of this study. Data collection was performed in a prospective manner for six months. The patients were monitored continuously until discharged from the ward. Results: A total of 40 patients were included in the study. 95% (n=38) of the patients were started with either intravenous amoxicillin/clavulanic acid (55%, n=22) or ampicillin/sulbactam (40%, n=16). 70% (n=28) were also initiated with a second antimicrobial, a third generation cephalosporin, ceftazidime. 67.5% (n=27) of the patients were initiated with two antimicrobials whilst 30% (n=12) were on one antimicrobial. Of the 29 cases reviewed (72.5%), all patients were given least two weeks of antibiotic inclusive of oral antimicrobial that was given on discharge, the remaining of the 11 of the cases (27.5%) were unknown due to the loss of follow up. Conclusions: There is a need for review of the current published guidelines on the choice of antimicrobial for treatment of CAPD peritonitis, CAPD Tenckhoff catheter exit site infections, haemodialysis venous catheter related infections and haemodialysis AV fistula related infections.
Keywords: Antimicrobial, empiric therapy, dialysis, line related sepsis, peritonitis
Correspondence: Lah Kheng CHUA. Department of Pharmacy, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam. Tel: +673 2242424 Ext 6477 . E mail: clk88@hotmail.com
Brunei Int Med J. 2013; 9 (6): 372-377