Colonization and risk of infection by multidrug-resistant bacteria in hemodialysis patients: a topic of concern

Abstract

Antimicrobial resistance worsens the prognosis in patients with chronic diseases. Patients on hemodialysis have infection rates that exceed those reported in other types of patients. Colonization has been suggested as a risk factor for the development of infections. However, the majority of the studies that have evaluated this association have methodological limitations that have called into question the validity of the results; such as the lack of use of molecular methods to confirm that the colonizing species are the same as that which causes infection, the measurement of exposure only at the beginning of the study, the absence of follow-up, the evaluation of bacteremia as the only important outcome and the focus only on Staphylococcus aureus, without including other resistant bacteria of clinical importance such as multidrug-resistant Gram-negative bacteria. This lead to the need to use molecular epidemiology methods for refine the association between colonization and infection in endemic countries like Colombia, where the high rates of antimicrobial resistance demand accurate prevention strategies in susceptible patients.