Colonisation with multidrug-resistant organisms among dialysis patients at Universitas Academic Hospital.

Background: While most infections with multidrug-resistant organisms (MDROs) affect colonised people, there is limited evidence on MDRO colonisation in South African dialysis patients. Objectives: This study evaluated the prevalence of MDRO colonisation among dialysis patients, the resistance patterns of each MDRO and the risk factors for colonisation. Method: Rectal and nasal swabs were collected from dialysis patients who consented to participate in a 5-month study to identify selected MDROs (April 2021 - August 2021). Specimens were cultured on selected chromogenic media. Data collected included demographics, clinical information from medical records and laboratory results. Results: Multidrug-resistant organisms were isolated from 17 (23.9%) of the 71 enrolled participants. Of the 23 MDRO strains from rectal swabs (n = 71), extended-spectrum beta-lactamase-producing Enterobacterales accounted for 21.1% (15/71), vancomycin-resistant enterococci 2.8% (n = 2/71) and carbapenem-resistant Enterobacterales 4.2% (n = 3/71). Klebsiella pneumoniae (65.2%, n = 15/23) was the most prevalent MDRO. More than 80% resistance to trimethoprim and sulfamethoxazole, cefotaxine, and ciprofloxacin was noted. Significant risk factors included previous hospitalisation, proton pump inhibitor use and antibiotic exposure in the past 6 months. Conclusion: Multidrug-resistant organisms' carriage was high in our dialysis population. The infection prevention and control measures need to be revised and strengthened. Contribution: This study falls within the scope of the SAJID journal as it is the first within sub-Sahara Africa to report that approximately one-fifth of dialysis patients were colonised with MDRO, which is a significant risk for MDRO infections.

Steady-state pharmacokinetics of lamivudine in end-stage kidney failure persons with detectable and undetectable HIV-1 RNA in peritoneal dialysis effluent.

BACKGROUND: Renally adjusted lamivudine dosages are effective. However, some of the kidney failure patients managed with lamivudine-containing regimens are failing to suppress HIV in peritoneal dialysis (CAPD) effluent. The steady-state lamivudine pharmacokinetics among these patients was evaluated. METHODS: This overnight open-label pharmacokinetic study enrolled participants living with HIV and managed with CAPD. Lamivudine levels in blood serum and CAPD effluent samples were quantified using liquid chromatography coupled with a mass spectrometer. Pharmacokinetic measures were obtained through non-compartmental analysis. RESULTS: Twenty-eight participants were recruited with a median antiretroviral (ARV) drug duration of 8 (IQR,4.5-10.5) years and a CAPD duration of 13.3 (IQR,3.3-31.9) months. 14.3% (4/28) had detectable unsuppressed HIV-1 viral load in CAPD effluents. The majority (78,6%,22/28) of participants received a 50 mg dose, while 10.7% (3/28), and another 10.7% (3/28) received 75 mg and 300 mg dosages, respectively. Among those treated with 75 and 300 mg, 66.7% (2/3) and 33.3% (1/3) had detectable HIV-VL in CAPD, respectively. The peritoneal membrane characteristics and CAPD system strengths were variable across the entire study population. Lamivudine exposure was increased in blood serum (50 mg-AUC0-24 h, 651.3 ng/mL; 75 mg-AUC0-24 h, 677.84 ng/mL; 300 mg-AUC0-24 h, 3135.89 ng/mL) compared to CAPD effluents (50 mg-AUC0-24 h, 384.91 ng/mL; 75 mg-AUC0-24 h, 383.24 ng/mL; 300 mg-AUC0-24 h, 2001.60 ng/mL) among the entire study population. The Cmax (50 mg, 41.5 ng/mL; 75 mg, 53.2 ng/mL; 300 mg, 199.1 ng/mL) and Cmin (50 mg, 17.8 ng/mL; 75 mg, 16.4 ng/mL; 300 mg, 76.4 ng/mL) measured in serum were within the therapeutic levels. CONCLUSIONS: Steady-state lamivudine pharmacokinetic measures were variable among the entire study population. However, the total lamivudine exposure was within the therapeutic levels.

The prevalence of HIV resistance mutations and their influence on the shedding of HIV-1 into peritoneal dialysis effluent.

HIV drug resistance mutations (HIVDRMs) are important determinants of therapeutic effects and outcomes even in end-stage kidney failure (ESKF) people living with HIV (PLWHIV). This study evaluated the prevalence of HIVDRMs and their effect on the shedding of HIV-1 into peritoneal dialysis (PD) effluents. This cross-sectional study of PLWHIV and having ESKF and managed with antiretroviral therapy (ART) and PD, collected enrolled patients' demographic information, clinical and laboratory data, and sequenced HIV-1 RNA in unsuppressed plasma and PD effluent samples. HIV viral load and HIVDRMs were determined using qualitative polymerase chain reaction (qPCR) and Stanford University HIVDRM Database, respectively. There were 60 participants recruited with a median age of 43.0 (interquartile range [IQR], 38.0-47) years and were predominantly on abacavir (88.3%), lamivudine (98.3%), and efavirenz (70%) for a median duration of 8 (IQR, 5-11) years. Among participants with detectable HIV-1 in PD effluents, the prevalence of HIVDRMs was 62.5% (5/8) compared to 7.7% (4/52) among those with undetectable HIV-1 (p = 0.001) with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations predominating. On Spearman's correlation analysis, high plasma HIV levels (ρ = 0.649, p < 0.001), T-cell CD4 count (ρ = -0370, p < 0.004), serum creatinine (ρ = -0.396, p < 0.002), and white blood cell count (ρ = -0.294, p < 0.023) levels were significant factors correlated with the detection of HIV-1 in PD effluents. Moreover, HIVDRMs presence (ρ = 0.504, p < 0.001) particularly NNRTI resistance (ρ = 0.504, p < 0.001) were also significantly correlated with detection of HIV-1 in PD effluents. The presence of HIVDRMs, high plasma HIV viral load, and T-cell CD4 count were correlated with HIV-1 shedding into PD effluents.

End-stage kidney disease and rationing of kidney replacement therapy in the free state province, South Africa: a retrospective study.

BACKGROUND: End-stage kidney disease (ESKD) and the required kidney replacement therapy (KRT) are significant public health challenges for low-and-middle-income countries. The South African government adopted a KRT rationing policy to balance the growing need for KRT and scarce resources. We aimed to describe the epidemiology and KRT access in patients with ESKD referred to the main public sector hospital in the Free State Province, South Africa. METHODS: A retrospective study of adult patients with ESKD admitted to Universitas Academic Hospital for KRT, was conducted between 1 January 2016 and 31 December 2018. A review of the KRT committee decisions to offer or deny KRT based on the KRT rationing policy of the Free State was undertaken. Demographic information, KRT committee outcomes, laboratory test results, and clinical details were collected from assessment tools, KRT committee meeting diaries, and electronic hospital records. RESULTS: Of 363 patients with ESKD referred for KRT access, 96 with incomplete records were excluded and 267 were included in the analysis. Median patient age was 40 (interquartile range, 33‒49) years, and male patients accounted for 56.2 % (150/267, p = 0.004) of the cohort. The average annual ESKD incidence was 49.9 (95 % confidence interval [CI], 35.8‒64.0) per-million-population. The most prevalent comorbidities were hypertension (42.3 %; 113/267), human immunodeficiency virus (HIV) (28.5 %; 76/267), and diabetes mellitus (19.1 %; 51/267). The KRT access rate was 30.7 % (82/267), with annual KRT incidence rates of 8.05 (95 % CI, 4.98‒11.1), 11.5 (95 % CI, 7.83‒15.1), and 14.1 (95 % CI, 10.3‒18.0) per-million-population in 2016, 2017, and 2018, respectively. Advanced organ dysfunction was the commonest reason recorded for KRT access denial (58.9 %; 109/185). Age (odds ratio [OR], 1.04; 95 % CI, 1.00‒1.07; p = 0.024) and diabetes (OR, 5.04; CI, 1.69‒15.03; p = 0.004) were independent predictors for exclusion from KRT, while hypertension (OR, 1.80; 1.06‒3.04; p = 0.029) independently predicted advanced organ dysfunction resulting in KRT exclusion. CONCLUSIONS: Non-communicable and communicable diseases, including hypertension, diabetes, and HIV, contributed to ESKD, highlighting the need for improved early prevention strategies to address a growing incidence rate. Two-thirds of ESKD patients were unable to access KRT, with age, diabetes mellitus, and advanced organ dysfunction being significant factors adversely affecting KRT access.

The prevalence and bacterial distribution of peritonitis amongst adults undergoing continuous ambulatory peritoneal dialysis at Universitas hospital.

BACKGROUND: Peritonitis is the leading cause of morbidity and technique failure in peritoneal dialysis (PD) patients. The International Society for Peritoneal Dialysis (ISPD) recommends each centre to monitor the peritonitis rates and the causative organisms in order to guide local empiric antibiotic protocols. The aim of this study was to report on the peritonitis rates and describe the causative microorganisms and the antibiotic susceptibility in continuous ambulatory peritoneal dialysis (CAPD) adult patients at the Universitas Academic Hospital. METHODS: A single-centre, retrospective descriptive survey was conducted to determine the peritonitis rates in PD patients (January-December 2016). All CAPD patients aged ≥18 years, who presented with clinical features of PD-associated peritonitis, were included. The peritonitis episodes were studied per patient, and the causative microorganisms and the antibiotic susceptibility of the organisms were described. RESULTS: One hundred and twenty-eight patients underwent CAPD. The peritonitis rate was 1.45 episodes per year at risk. The prevalence of CAPD patients affected by at least one episode of CAPD-associated peritonitis during 2016 was 56.3%. The majority of episodes (76.7%) (n = 122) were mono-microbial. Gram-positive organisms accounted for 73.0% (n = 116) of the peritonitis episodes, coagulase-negative Staphylococcus being the most common. Gram-negative organisms accounted for 15.7% (n = 25) of the peritonitis episodes, and the common pathogens was Enterobacteriaceae. CONCLUSION: The peritonitis rate was alarmingly high, with 1.45 episodes per year at risk; this is three times more than the recommended 0.5 episodes per year according to the ISPD guidelines. The culture-negative rate of 8.8% is within ISPD-acceptable limits. There is a need to strengthen preventive measures with regard to peritonitis.