Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study
Abstract Background Critically ill patients receiving continuous renal replacement therapy (CRRT) are at increased risk for multidrug-resistant infections and infection-related mortality. Altered pharmacokinetics in CRRT may contribute to inadequate antimicrobial exposure and therapeutic failure. Ho...
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2025-07-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-025-04272-3 |
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| author | Danica Quickfall Ashley La Jennifer Pisano Patrick Costello Samantha Gunning Jay L. Koyner |
| author_facet | Danica Quickfall Ashley La Jennifer Pisano Patrick Costello Samantha Gunning Jay L. Koyner |
| author_sort | Danica Quickfall |
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| description | Abstract Background Critically ill patients receiving continuous renal replacement therapy (CRRT) are at increased risk for multidrug-resistant infections and infection-related mortality. Altered pharmacokinetics in CRRT may contribute to inadequate antimicrobial exposure and therapeutic failure. However, limited data exist on infection burden and resistance patterns specific to this population. Methods We conducted a retrospective cohort study of ICU patients receiving continuous venovenous hemodialysis (CVVHD) at a tertiary academic center between May 2016 and April 2020. Patients were included if they received CRRT for ≥ 48 h, had at least one positive microbial culture, and received at least one antimicrobial of interest. Data were collected on infection sources, pathogens, resistance patterns, and mortality. Results Among 661 CRRT recipients, 394 (59.6%) had at least one positive culture. The most common infection sites were respiratory (69.0%), skin and soft tissue (53.8%), and intra-abdominal (38.8%). Intra-abdominal and bloodstream infections had the highest mortality (63.7% and 57.7%, respectively). Vancomycin-resistant E. faecium (83.3%), cefepime-resistant A. baumannii (100%), and P. aeruginosa with high β-lactam resistance were prominent. These resistance profiles diverged from general ICU trends. Conclusion ICU patients receiving CRRT experience high rates of multidrug-resistant infections and associated mortality. Tailored dosing strategies, including dual empiric coverage in select cases, and CRRT-specific antimicrobial stewardship are essential to improve outcomes in this high-risk population. |
| format | Article |
| id | doaj-art-c8272ba10aa04f51af5cf552c545deaf |
| institution | Kabale University |
| issn | 1471-2369 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj-art-c8272ba10aa04f51af5cf552c545deaf2025-08-20T03:45:23ZengBMCBMC Nephrology1471-23692025-07-0126111110.1186/s12882-025-04272-3Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort studyDanica Quickfall0Ashley La1Jennifer Pisano2Patrick Costello3Samantha Gunning4Jay L. Koyner5Committee on Clinical Pharmacology and Pharmacogenomics, University of ChicagoSection of Nephrology, Department of Medicine, University of ChicagoSection of Infectious Diseases and Global Health, Department of Medicine, University of ChicagoDepartment of Pharmacy, University of Chicago MedicineSection of Nephrology, Department of Medicine, University of ChicagoCommittee on Clinical Pharmacology and Pharmacogenomics, University of ChicagoAbstract Background Critically ill patients receiving continuous renal replacement therapy (CRRT) are at increased risk for multidrug-resistant infections and infection-related mortality. Altered pharmacokinetics in CRRT may contribute to inadequate antimicrobial exposure and therapeutic failure. However, limited data exist on infection burden and resistance patterns specific to this population. Methods We conducted a retrospective cohort study of ICU patients receiving continuous venovenous hemodialysis (CVVHD) at a tertiary academic center between May 2016 and April 2020. Patients were included if they received CRRT for ≥ 48 h, had at least one positive microbial culture, and received at least one antimicrobial of interest. Data were collected on infection sources, pathogens, resistance patterns, and mortality. Results Among 661 CRRT recipients, 394 (59.6%) had at least one positive culture. The most common infection sites were respiratory (69.0%), skin and soft tissue (53.8%), and intra-abdominal (38.8%). Intra-abdominal and bloodstream infections had the highest mortality (63.7% and 57.7%, respectively). Vancomycin-resistant E. faecium (83.3%), cefepime-resistant A. baumannii (100%), and P. aeruginosa with high β-lactam resistance were prominent. These resistance profiles diverged from general ICU trends. Conclusion ICU patients receiving CRRT experience high rates of multidrug-resistant infections and associated mortality. Tailored dosing strategies, including dual empiric coverage in select cases, and CRRT-specific antimicrobial stewardship are essential to improve outcomes in this high-risk population.https://doi.org/10.1186/s12882-025-04272-3Continuous renal replacement therapyAntimicrobial resistanceCritical careInfection-related mortality |
| spellingShingle | Danica Quickfall Ashley La Jennifer Pisano Patrick Costello Samantha Gunning Jay L. Koyner Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study BMC Nephrology Continuous renal replacement therapy Antimicrobial resistance Critical care Infection-related mortality |
| title | Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study |
| title_full | Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study |
| title_fullStr | Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study |
| title_full_unstemmed | Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study |
| title_short | Infections and mortality in ICU patients undergoing continuous renal replacement therapy: a retrospective cohort study |
| title_sort | infections and mortality in icu patients undergoing continuous renal replacement therapy a retrospective cohort study |
| topic | Continuous renal replacement therapy Antimicrobial resistance Critical care Infection-related mortality |
| url | https://doi.org/10.1186/s12882-025-04272-3 |
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