Fecal carriage of extended-spectrum β-lactamase-producing, and carbapenem-resistant gram-negative bacteria among hemodialysis patients in a palestinian tertiary care hospital

Abstract

Abstract The study explores the presence of extended-spectrum β-lactamase-producing Gram-negative bacteria (ESBL-GNB) and carbapenem-resistant Gram-negative bacteria (CR-GNB) in the stool of hemodialysis patients, reflecting a significant concern amid rising antibiotic resistance. This cross-sectional study included 137 outpatients conducted from October to December 2023 at An-Najah National University Hospital. Samples were incubated on appropriate MacConkey-based agar for bacterial analysis, and potential risk factors were evaluated using logistic regression. Out of 137 stool samples, 116 (84.7%) were positive for ESBL-producing bacteria, and 8 (5.8%) for carbapenem-resistant bacteria. Age of the patients (aOR: 1.068; p: 0.012), hypertension (aOR: 15.582; p: 0.0107), ischemic heart disease (aOR: 5.381; p: 0.040), the timing of the dialysis shift (aOR: 8.864; p: 0,005), and the level of blood urea nitrogen (aOR: 1.049; p: 0.045) were independently associated with ESBL-GNB colonization. Carbapenem-resistant bacteria colonization presented an inverse association with ischemic heart disease (aOR: 0.052; p: 0.041). This study highlights a significant prevalence of ESBL-GNB colonization linked with age and comorbidities such as hypertension. An inverse association of CR-GNB colonization with ischemic heart disease was observed, suggesting a complex interplay between patient health status and antibiotic-resistant bacterial colonization.

Keywords

• Antimicrobial resistance
• Extended-spectrum β-lactamase
• Carbapenem-resistant
• Fecal colonization
• Hemodialysis
• Fecal indicator bacteria