This study systematically reviews epidemiological data on antibiotic use among dialysis patients globally, revealing high prevalence of inappropriate prescriptions and emphasizing the necessity of antimicrobial stewardship programs in dialysis settings. The article summarizes antibiotic usage patterns and prescription inappropriateness types and proportions, providing theoretical support for optimizing clinical antibiotic management.
Literature Overview
This paper titled 'Prevalence and Types of Inappropriate Antibiotics Prescribing Among Dialysis Patients: A Systematic Review' published in the journal Antibiotics reviews and summarizes the current status and prescription appropriateness of antibiotic use in dialysis patients worldwide. The study found that antibiotic usage rates among dialysis patients are significantly higher than general hospitalized patients, with numerous broad-spectrum antibiotic prescriptions often lacking clear indications or containing dosage errors.
Background Knowledge
Chronic kidney disease (CKD) has become a global health issue affecting approximately 10% of the population. As the disease progresses to end-stage renal disease (ESRD), patients require dialysis or kidney transplantation to sustain life. Due to compromised immune function, frequent vascular access exposure, and multiple comorbidities, dialysis patients face significantly increased infection risks, leading to frequent antibiotic use. However, antibiotic pharmacokinetics differ in these patients compared to the general population, and inappropriate use may lead to treatment failure, toxicity, or drug resistance. This study aims to evaluate prescription prevalence, types, and appropriateness to provide evidence for antimicrobial stewardship (AMS).
Research Methods and Experiments
The research team systematically searched four major databases (PubMed, Embase, Scopus, CINAHL) and supplemented with Google Scholar and reference list screenings for studies on antibiotic use in dialysis patients from database inception to October 2024. Included studies were limited to English literature, with assessment of methodological quality and prescription appropriateness standards. Data extraction included prescription rates, types, dosing regimens, indications, and error classifications.
Key Conclusions and Perspectives
Research Significance and Prospects
The study underscores the widespread inappropriate antibiotic prescriptions in dialysis patients, particularly discrepancies in dosing and indications. Future initiatives should promote antimicrobial stewardship programs in dialysis facilities through clinical pharmacist involvement, prescription review and feedback mechanisms, dosage optimization, and therapeutic drug monitoring to improve prescription quality and reduce resistance development. Additionally, further research on antibiotic pharmacokinetics across different dialysis modalities is required to establish more precise dosing guidelines.
Conclusion
This systematic review reveals the high prevalence of inappropriate antibiotic prescriptions among dialysis patients, including dosage errors, lack of clear indications, and inappropriate antimicrobial spectrum selection. Both prescription rates and inappropriate rates exceed hospitalized patients, emphasizing the urgent need for enhanced antimicrobial stewardship in dialysis facilities. Optimizing prescription practices can reduce risks of multidrug-resistant infections and improve patient outcomes. The study also highlights the potential role of clinical pharmacists in prescription optimization, providing theoretical support for implementing antimicrobial stewardship programs in dialysis settings.
