Optimizing Antibiotic Strategies for Arteriovenous Fistula Infections in Dialysis Patients: A Microbiological and Cephalosporin Susceptibility Analysis

Background: Arteriovenous fistula infections are a significant complication in dialysis patients, jeopardizing vascular access. Understanding the bacterial profile and antibiotic susceptibility is crucial for optimal treatment. Methods: This cross-sectional study investigated bacteria isolated from AV fistula infections and their susceptibility to various cephalosporin generations in dialysis patients (n=100) from two Iraqi hospitals between July and October 2020. Bacterial identification was performed using the API 20 test system, and antibiotic susceptibility testing employed the Kirby-Bauer disk diffusion or broth microdilution method. Results: Staphylococcus aureus (55%) was the most prevalent bacteria, followed by Klebsiella spp. (15%), Pseudomonas spp. (15%), and Acinetobacter spp. (10%). First-generation cephalosporins exhibited limited efficacy against most isolates. Second-generation options showed improved activity against some bacteria. Third-generation cephalosporins demonstrated the broadest spectrum of activity, but concerns remain regarding resistance selection. Fourth and fifth-generation options were likely highly effective but should be reserved for severe infections. Conclusions: S. aureus was the dominant pathogen. While third-generation cephalosporins appear most effective for initial empiric therapy, definitive treatment should be guided by susceptibility testing. This study highlights the importance of tailoring antibiotic selection to the specific bacterial profile to minimize resistance development in dialysis patients.