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End stage renal disease (ESRD) patients on renal replacement therapy (RRT) have an increased risk of morbidity and mortality due to healthcare associated infections (HCAIs). The aim of this study is to determine the prevalence, microbial etiology, and risk factors associated with HCAIs among ESRD patients on RRT. A multicenter, retrospective study was conducted from June to December 2019. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients <18 years were excluded. To reduce the risk of selection bias, all patients were randomly selected using a simple random sampling technique. The prevalence showing the proportion of patients that acquired HCAI since the initiation of dialysis until 2019 was calculated using the European patients' academy (EUPATI) formula. Risk factors were assessed using univariate and multivariate regression analysis. The prevalence of HCAI among ESRD patients was 174/400 (43.5%). Catheter related bloodstream infection (CRBSI) was the most common infection [64(36.8%)], followed by peritonitis [45(25.8%)] and pneumonia [37(21.2%)]. Out of 382 total pathogens identified, 204 (53.4%) were Gram positive and 162 (42.4%) were Gram negative. Both methicillin sensitive staphylococcus aureus (MSSA) and methicillin resistant staphylococcus aureus (MRSA) showed statistically significant associations (p<0.05) with CRBSI. Use of multiple accesses, increased blood sugar levels, low serum sodium levels and higher CRP concentration increased the occurrence of HCAIs. The burden of HCAIs among the patients undergoing RRT is high. Preventive strategies and optimum empirical therapy of antibiotics should be used to reduce the risk of these infections among ESRD patients. [ABSTRACT FROM AUTHOR]

The global prevalence of chronic kidney disease (CKD) is between 11 to 13%. Renal replacement therapies (RRT) – which include dialysis and renal transplantation – consume a significant portion of a country’s health resources even though only 0.1% of all CKD patients are at stage 5, also known as end-stage renal disease (ESRD). The aim of this review was to compare the magnitude of the economic burden of ESRD on national healthcare systems of selected countries with high prevalence of ESRD including Malaysia. The quantity of interest in this review were total ESRD expenditures and its proportions to the national health systems' expenditure. It was identified that total ESRD expenditure contributes between 0.91% to 7.1% of national health system expenditure in countries selected for this review. In Malaysia, the public sector - through its various agencies at the federal and state levels, accounted for almost 70% of dialysis funding; the remaining 30% came from the private sector and out-of-pocket payments. The ESRD expenditures in Malaysia constitutes 4.2% of total health expenditure by the public sector, relatively high compared to other countries. This review will summarise findings of the currently available economic evaluations of RRT in Malaysia. Based on available evidence, estimated weighted cost of treating ESRD patient in Malaysia is MYR39,346 per patient per year (USD26,648, PPP 2016). [ABSTRACT FROM AUTHOR]

End stage renal disease (ESRD) patients have an increased risk of morbidity and mortality due to infections, as these patients have multiple comorbidities, may suffer frommalnutrition, and have profound alterations in their immune system. To determine the prevalence of healthcare associated infections (HCAIs) and their microbial etiology among ESRD patients undergoing renal replacement therapy (RRT).A multicenter, retrospective study of patients on RRT was conducted from June 2019 to December 2019 at two hospitals, including university of Malaya medical centre (UMMC) and hospital Serdang. ESRD patients with minimum of 6 months on RRT were included in this study, while pregnant patients and patients below the age of 18 years were excluded. To confirm the diagnosis of HCAI, patient had to fulfil at least one of the following criteria: 1) attended a hospital, received intravenous therapy, wound care or specialized nursing care in 30 days before the infection or 2) was hospitalized in an acute care hospital for 2 or more days in the previous 90 days. A data collection form was used to retrieve all sociodemographic and clinical data. To reduce the risk of selection bias, all patients were randomly selected using an online tool; research randomizer, which utilizes total number of patients and the sample size to generate random numbers. The period prevalence showing the proportion of patients that acquired HCAI since the initiation of dialysis till 2019, was calculated using a formula stated by European patients' academy (EUPATI). Total of 670 records were examined, out of which 400 patients were selected based on the inclusion criteria. There were 174 patientswith at least one episode of HCAI,hencethe period prevalence was found to be 43.5%. Catheter related blood stream infection (CRBSI) was the most common infection and occurred in 64 (36.8%) patients, while peritonitis and pneumonia were identified in 44 (25.8%) and 36 (21.2%) patients, respectively. Out of 382 total pathogens identified through microbial culture, 204 (53.4%) were gram-positive and 162 (42.4%) were gramnegative. Among the gram-positive organisms,Staphylococcus aureuswas identified in 90 (23.5%) patients, while Staphylococcus epidermidis and Streptococcus spp. were seen in 42 (10.9%) and 24 (6.28%) patients, respectively. Klebsiella pneumonia, which was found in 36 (9.42%) patients, was most frequently identified gram-negative organism. Moreover, Candida spp. were the only fungal organisms found in this study. Both methicillin sensitive S. aureus(MSSA) and methicillin resistant S. aureus(MRSA) showed statistically significant associations (p = <0.05) with CRBSI, while MSSA and klebsiella pneumonia showed similar associations (p = <0.05) with pneumonia. High prevalence of HCAIs was found among ESRD patients undergoing RRT, which is quite alarming. Furthermore, broad range of pathogens were also identified to be associated with these infections. [ABSTRACT FROM AUTHOR]