Oosterwijk, P.R. (2012) Dragerschap van Extended-Spectrum Beta-Lactamases (ESBL’s) bij hemodialysepatiënten Retrospectief onderzoek naar het nut van routinematige screening naar ESBL-dragerschap en contactisolatie tijdens dialyseren. thesis, Medicine.
Full text available on request.Abstract
Background: Antibiotic resistance due to Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria is rising. When treating infections caused by these bacteria, the choice of antibiotics is limited. Hemodialysis patients are at risk of becoming ESBL-carriers, but epidemiological data towards ESBL-carriage in this specific patient group is scarce. Methods: A single center retrospective research was conducted in which, from March 2009 to March 2012, the prevalence of ESBL-positive dialysis patients was determined during six screening rounds. If patients were tested ESBL-positive, barrier precautions were taken. Subsequently 120 dialysis patients, selected from the six screening rounds, were included in a case control design. A risk factor analysis for ESBL-carriage was conducted. Survival between ESBL-positive versus ESBL-negative patients was compared, and with Amplified-Fragment Length Polymorphism (AFLP)-typing spread of single strains was investigated. Results: During the study period the prevalence of ESBL-positive patients varied from 5,8% to 11,1%, this variation was not significant. The prevalence of the dialysis population corresponded with the prevalence within the regular population of the Deventer region (8,3%). After multi-variate risk factor analysis, antibiotic use preliminary to sampling (OR: 6,167 95%CI: 2,288-16,624) and residence in a long term care facility (OR: 3,697 95%CI: 1,171-11,674) were significant risk factors for ESBL-carriage. Survival did not differ significantly between ESBL-positive and ESBL-negative dialysis patients. AFLP-typing revealed 3 strains colonized more than one patient. Patient to patient spread was considered unlikely. Conclusion: In this single center hemodialysis population, the prevalence of ESBL-positive patients did not change significantly. The prevalence of ESBL-positive bacteria corresponded with the prevalence within the regular population. ESBL-carriage is dependent on multiple factors, in which previous antibiotic use and residence in a long term care facility seem to play an important role. ESBL-carriage is not associated with a decreased survival in hemodialysis patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Sluiter, dr H.E. internist nefroloog and Deventer Ziekenhuis, Deventer and Hemodialyse afdeling |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2608 |
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