Antibiotic use and determinants among patients with chronic kidney disease: Findings and implications

Abstract

Objectives: Patients with chronic kidney disease (CKD) frequently require antibiotic therapy due to increased susceptibility to infections. However, inappropriate antibiotic use can worsen renal function and contribute to the emergence of antimicrobial resistance (AMR). This study aimed to assess the prevalence and prescribing patterns of antibiotic use and determine factors associated with antibiotic use in the CKD population. Material and Methods: This study employed a retrospective, cross-sectional design in a Nigerian secondary-level hospital. Case files of patients treated for CKD between January and December 2023 were systematically reviewed. Information on sociodemographic variables, clinical features, and prescribed antibiotics was collected and analysed using IBM SPSS Statistics version 25.0. Results: Of the 390 patients with CKD assessed, half were prescribed at least one antibiotic during the study period. Among those exposed to antibiotics, single-agent therapy predominated. The most frequently used agents were ceftriaxone (21.0%), amoxicillin–clavulanic acid (18.5%), and ciprofloxacin (7.2%). Based on the access, watch, and reserve (AWaRe) framework of the World Health Organization (WHO), most prescribed antibiotics fell within the Watch category (59.3%), while the remainder were classified as Access agents (40.3%). Bivariate analysis showed statistically significant associations between antibiotic use and both employment status and the presence of comorbidities ( p = 0.019 and p = 0.011, respectively); however, these relationships were not sustained after adjustment in multivariable analysis. Conclusion: Overall, antibiotic prescribing was frequent among patients with CKD, and treatment patterns were largely characterised by the use of broad-spectrum antibiotics and those categorised under the watch group. Rational prescribing guided by antimicrobial stewardship (AMS) programs is essential to reduce risks of AMR and renal toxicity.