ANTIMICROBIAL RESISTANCE OF GRAM POSITIVE BACTERIA ISOLATED LNPATLENTS WLTHCHRONLCKLDNEYDLSEASSTAGE5D: PREVALENCE AND OUTCOMES

Bacterial infections in chronic kidney disease stage VD (CKD VD st.)patients are associated with increased risk of hospitalization and death. The aim was to study of opportunistic pathogenic bacteria spectrum, their antibacterial resistance and the correlation between carriage and hospitalization and mortality rate in adult patients with CKD V D st. Materials and methods. This prospective cohort, open-label, randomized, two-phase study included 146 patients with CKD V D st., 118 of whom were treated by hemodialysis (HD) and 28 by peritoneal dialysis (PD). The microbiological screening was conducted in the first stage. The examined material was throat/nose swabs and wet smears from skin of dialysis access site. On the second stage all patients were randomized on two groups: the group 1 (n=61) included patients with identified MRSA / VRE colonization and group 2 (n=85) included patients with colonization of other strains of opportunistic pathogenic bacteria. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The microbiological examination consisted of inoculation of hard medium by examined material. The end points were total amount of hospitalization and death events evaluated for 24 months after randomization. Results. The colonization of some biotype of opportunistic pathogenic bacteria was established in 100% ofpatients. In total were isolated 347 strains of gram-positive bacteria: 284 and 63 in HD and PD patients, respectively. Without statistical significance approximately 20% of microorganism strains were resistant to 10 and more antibiotics according to dialysis modality. The MRSA colonization was identified in 49 (33.6%) patients (37/31.4% and 12/42.9% of HD u PD patients, respectively; p=0,246). The VRE colonization was established in 12 patients (10/8.5% and 2/7.1% of HD and PD patients, respectively; p=0.81). The 70 hospitalization episodes were recorded during monitoring period. The significant majority was established in group 1 of patients (39/64% vs. 31/36.5 %; χ2=10.733, p=0,001) irrespective ofRRTmodality. The specific share ofdead persons in group 1 was in three times more than such share in group 2 (9/14.8% vs. 4/4.7 %; χ2=4.42, p= 0.0355). The relative risks of hospitalization and death in the presence of MRSA/VRE colonization increased in 1.75 (95% CI: 1.252.5) and 3.14(95% CI: 1.01-9.7) times. Conclusion. In this study was demonstrated that MRSA/VRE colonization in adult patients with CKD V D st. is a risk marker and a predictor of negative clinical prognosis. The RRT modality hadn't significant effect on rate of negative consequences, particularly on rate of hospitalization and death in population of CKD V D st. patie