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. 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.