Fecal carriage of extended-spectrum β-lactamase-producing, and carbapenem-resistant gram-negative bacteria among hemodialysis patients in a palestinian tertiary care hospital.

The study explores the presence of extended-spectrum β-lactamase-producing Gram-negative bacteria (ESBL-GNB) and carbapenem-resistant Gram-negative bacteria (CR-GNB) in the stool of hemodialysis patients, reflecting a significant concern amid rising antibiotic resistance. This cross-sectional study included 137 outpatients conducted from October to December 2023 at An-Najah National University Hospital. Samples were incubated on appropriate MacConkey-based agar for bacterial analysis, and potential risk factors were evaluated using logistic regression. Out of 137 stool samples, 116 (84.7%) were positive for ESBL-producing bacteria, and 8 (5.8%) for carbapenem-resistant bacteria. Age of the patients (aOR: 1.068; p: 0.012), hypertension (aOR: 15.582; p: 0.0107), ischemic heart disease (aOR: 5.381; p: 0.040), the timing of the dialysis shift (aOR: 8.864; p: 0,005), and the level of blood urea nitrogen (aOR: 1.049; p: 0.045) were independently associated with ESBL-GNB colonization. Carbapenem-resistant bacteria colonization presented an inverse association with ischemic heart disease (aOR: 0.052; p: 0.041). This study highlights a significant prevalence of ESBL-GNB colonization linked with age and comorbidities such as hypertension. An inverse association of CR-GNB colonization with ischemic heart disease was observed, suggesting a complex interplay between patient health status and antibiotic-resistant bacterial colonization.
Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted with the full approval of the Institutional Review Board (IRB) at An-Najah National University (Ref: Med. Sept. 2023/2). The IRB reviewed all aspects of the study protocol, including procedures for accessing and utilizing patient clinical information. All collected data were employed exclusively for this clinical research project and were maintained with strict confidentiality. Patient data and hospital details were anonymized through a coding system, allowing access to the information only for authorized research staff to maintain confidentiality. Written informed consent was obtained from each participant before their inclusion in the study. The research methodology followed all relevant ethical guidelines and regulations. Consent for publication: All authors approved the manuscript and gave their consent for submission and publication. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)