Epidemiology, management and consequences of infection: a nephrology perspective

R Medicine (General)

Helps, Aileen ; Mactier, Robert

University:University of Glasgow

Department:Institute of Infection Immunity and Inflammation

关键词: nephrology, bacteraemia, clostridium difficile, staphylococcus, antibiotic, gentamicin, diarrhoea;   

Others  :  http://theses.gla.ac.uk/5192/7/2014helpsmd.pdf

来源: University of Glasgow

【 摘 要 】

Healthcare associated infection confers a significant burden of morbidity and mortality to renal patients and to renal dialysis patients in particular. Sepsis is second only to cardiovascular disease as the leading documented cause of death in patients requiring renal replacement therapy. Gram positive bacteraemia is common in the renal replacement therapy population and is highly associated with indwelling haemodialysis catheter use. Optimal prevention and management of bacteraemia in this setting has not been fully determined and requires a multidisciplinary and multifaceted approach.Each of the studies in this thesis investigates an aspect of healthcare associated infection in nephrology within the theme of exploring clinical problems arising from the development of antibiotic resistance or antibiotic associated infections in renal patients.Initially we examined risk factors and outcomes of acute kidney injury requiring renal replacement therapy in a tertiary renal unit and critical care population prior to and subsequent to a change in antimicrobial guidelines in response to an outbreak of Clostridium difficile associated disease. We performed this study to address concerns that the increase in the empiric use of gentamicin may have led to an increased incidence of acute kidney injury and a greater requirement for emergency renal replacement therapy.Secondly we explored the clinical implications of gram positive infection in a renal unit population by performing a retrospective review of Staphylococcus aureus and coagulase negative staphylococcal bacteraemia over a 2 year period with particular attention to admission rates, vascular access intervention, antibiotic resistance, metastatic infection and mortality.Thirdly we have analysed S. aureus toxin genes and assessed the epidemiology of S. aureus colonisation and infection to improve our understanding of the virulence of S. aureus in different patient populations including a large haemodialysis unit in Glasgow.Finally we undertook a prospective double blind randomised controlled trial of probiotic milk drink and placebo in renal unit inpatients commencing antibiotic therapy to assess if a probiotic was effective in the prevention of antibiotic associated diarrhoea and Clostridium difficile associated diarrhoea. We performed this study as patients with chronic kidney disease are at increased risk of infection and have a significant antibiotic burden, which can lead to antimicrobial resistance, antibiotic associated diarrhoea and pseudomembranous colitis due to Clostridium difficile infection.The study of healthcare associated infection is an evolving field and involves complex interactions between colonisation and infection. There is increasing emphasis on prevention of infection and minimising complications and side effects associated with standard antimicrobials. The rising incidence of multiresistant bacterial infections is likely to result in increasing focus on preventive bundles of care and alternatives to antimicrobial therapy such as the use of probiotics. The findings of this thesis contribute to the goal of prevention of antibiotic resistance and multiresistant infections in renal patients although further research is required.