{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:32:28Z","timestamp":1789997548204,"version":"4.0.1"},"reference-count":51,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>End-stage chronic kidney disease markedly increases susceptibility to infections due to compromised immune function and other physiological alterations. Bacteremia is responsible for higher mortality rates in hemodialysis patients compared to the general population. Our study aimed to investigate the incidence and clinical outcomes among patients with end-stage CKD and associated infections. The study retrospectively analyzed admitted patients between 1 January 2023 and 31 May 2025. Among 56 hospitalized patients with CKD and infection (30 hemodialysis [HD], 26 non-HD), baseline comorbidity profiles were broadly comparable. Microbiology was frequently positive (46\/56, 82.1%), dominated by Staphylococcus aureus (25\/98, 25.5%), Klebsiella pneumoniae (19.98, 19.4%), and Escherichia coli (15\/98, 15.3%). Crude in-hospital mortality was higher in HD (46.7% vs. 15.4%; p = 0.012; RR 3.03). In multivariable logistic regression, HD remained independently associated with death (adjusted OR 38.22, 95% CI 1.55\u2013940.53; p = 0.026), alongside hypotension (OR 17.55, 1.46\u2013210.92; p = 0.024) and male sex (OR 4.41, 1.29\u201315.11; p = 0.018); model performance was strong (AUC 0.867). In this single-center cohort of infected patients with end-stage CKD, maintenance hemodialysis was independently associated with higher in-hospital mortality, even after adjustment for age, sex, comorbidity burden, hypotension, and length of stay; hypotension and male sex were additional risk factors. LOS and most presenting features did not differ meaningfully by dialysis status. Our findings also emphasize the urgent necessity for heightened surveillance of local antimicrobial resistance patterns and underscore the profound vulnerability of hemodialysis patients to severe infectious outcomes, which is exacerbated by immunosuppressive conditions and the limited efficacy of available therapeutic options against resistant pathogens.<\/jats:p>","DOI":"10.3390\/microorganisms14010230","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:57:02Z","timestamp":1768816622000},"page":"230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Characteristics of Infections in Hemodialysis Patients: Results from a Single-Center 29-Month Observational Cohort Study from Romania"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7391-3394","authenticated-orcid":false,"given":"Victoria","family":"Birlutiu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7400-2904","authenticated-orcid":false,"given":"Rares-Mircea","family":"Birlutiu","sequence":"additional","affiliation":[{"name":"Department 14-Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Foisor Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref_1","unstructured":"United States Renal Data System (2016). USRDS 2016 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"A7","DOI":"10.1053\/j.ajkd.2016.12.004","article-title":"US Renal Data System 2016 Annual Data Report: Epidemiology of Kidney Disease in the United States","volume":"69","author":"Saran","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_3","first-page":"S91","article-title":"Polymorphonuclear cell function and infection in dialysis","volume":"38","author":"Vanholder","year":"1992","journal-title":"Kidney Int. Suppl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1093\/ndt\/15.11.1827","article-title":"Catalytically active iron and bacterial growth in serum of haemodialysis patients after i.v. iron-saccharate administration","volume":"15","author":"Parkkinen","year":"2000","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1136\/thoraxjnl-2013-204282","article-title":"Risk factors for community-acquired pneumonia in adults in Europe: A literature review","volume":"68","author":"Torres","year":"2013","journal-title":"Thorax"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.kint.2016.07.013","article-title":"Infection in advanced chronic kidney disease leads to increased risk of cardiovascular events, end-stage kidney disease and mortality","volume":"90","author":"Tang","year":"2016","journal-title":"Kidney Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1097\/01.ASN.0000074237.78764.D1","article-title":"Impact of Dialysis Dose and Membrane on Infection-Related Hospitalization and Death","volume":"14","author":"Allon","year":"2003","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.2215\/CJN.01290308","article-title":"Epidemiology of Acute Infections among Patients with Chronic Kidney Disease","volume":"3","author":"Dalrymple","year":"2008","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.clim.2005.09.007","article-title":"Progressive loss of renal function is associated with activation and depletion of naive T lymphocytes","volume":"118","author":"Litjens","year":"2006","journal-title":"Clin. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1038\/sj.ki.5002425","article-title":"Uremia impairs monocyte and monocyte-derived dendritic cell function in hemodialysis patients","volume":"72","author":"Lim","year":"2007","journal-title":"Kidney Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1159\/000276764","article-title":"Leukocyte Toll-Like Receptor Expression in End-Stage Kidney Disease","volume":"31","author":"Gollapudi","year":"2010","journal-title":"Am. J. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1053\/j.ackd.2006.04.007","article-title":"Overview of Vaccination in Chronic Kidney Disease","volume":"13","author":"Kausz","year":"2006","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1086\/501998","article-title":"Bloodstream infections in hemodialysis patients: Getting some deserved attention","volume":"23","author":"Tokars","year":"2002","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1159\/000187285","article-title":"Bacteremia in patients on chronic hemodialysis. A multicenter prospective survey","volume":"64","author":"Kessler","year":"1993","journal-title":"Nephron"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1097\/01.ASN.0000119144.95922.C4","article-title":"Septicemia in the United States dialysis population, 1991 to 1999","volume":"15","author":"Foley","year":"2004","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1111\/j.1523-1755.2000.00337.x","article-title":"Mortality caused by sepsis in patients with end-stage renal disease compared with the general population","volume":"58","author":"Sarnak","year":"2000","journal-title":"Kidney Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1067\/mic.2002.120904","article-title":"New national surveillance system for hemodialysis-associated infections: Initial results","volume":"30","author":"Tokars","year":"2002","journal-title":"Am. J. Infect. Control"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.2215\/CJN.11411116","article-title":"National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014","volume":"12","author":"Nguyen","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/j.1525-139X.2008.00497.x","article-title":"Infection associated with tunneled hemodialysis catheters","volume":"21","author":"Beathard","year":"2008","journal-title":"Semin. Dial."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1378\/chest.120.6.1883","article-title":"Pulmonary Infectious Mortality Among Patients With End-Stage Renal Disease","volume":"120","author":"Sarnak","year":"2001","journal-title":"Chest"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1053\/j.ajkd.2011.07.012","article-title":"The Risk of Infection-Related Hospitalization With Decreased Kidney Function","volume":"59","author":"Dalrymple","year":"2012","journal-title":"Am. J. Kidney Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1053\/j.ajkd.2009.04.005","article-title":"CKD and Risk of Hospitalization and Death With Pneumonia","volume":"54","author":"James","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1001\/archinte.168.21.2333","article-title":"Risk of Bloodstream Infection in Patients With Chronic Kidney Disease Not Treated With Dialysis","volume":"168","author":"James","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1681\/ASN.2013101062","article-title":"The Uremic Toxicity of Indoxyl Sulfate and p-Cresyl Sulfate","volume":"25","author":"Vanholder","year":"2014","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1093\/ndt\/gfl584","article-title":"P-cresylsulphate, the main in vivo metabolite of p-cresol, activates leucocyte free radical production","volume":"22","author":"Schepers","year":"2006","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3057","DOI":"10.1038\/s41598-017-03130-z","article-title":"Indoxyl sulfate (IS)-mediated immune dysfunction provokes endothelial damage in patients with end-stage renal disease (ESRD)","volume":"7","author":"Kim","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1681\/ASN.2012030281","article-title":"Protein-Bound Uremic Toxins Stimulate Crosstalk between Leukocytes and Vessel Wall","volume":"24","author":"Pletinck","year":"2013","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3693","DOI":"10.1093\/ndt\/gfq251","article-title":"Serum protein-bound uraemic toxins and clinical outcomes in haemodialysis patients","volume":"25","author":"Lin","year":"2010","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e5799","DOI":"10.1097\/MD.0000000000005799","article-title":"Free and total p-cresol sulfate levels and infectious hospitalizations in hemodialysis patients in CHOICE and HEMO","volume":"96","author":"Banerjee","year":"2017","journal-title":"Medicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1056\/NEJMoa1109400","article-title":"Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk","volume":"368","author":"Tang","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/nature09922","article-title":"Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease","volume":"472","author":"Wang","year":"2011","journal-title":"Nature"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1146\/annurev-nutr-071816-064732","article-title":"Trimethylamine N-Oxide, the Microbiome, and Heart and Kidney Disease","volume":"37","author":"Zeisel","year":"2017","journal-title":"Annu. Rev. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.jacc.2017.05.034","article-title":"Basic Biology of Oxidative Stress and the Cardiovascular System","volume":"70","author":"Sack","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.semnephrol.2004.06.026","article-title":"Oxidative stress in uremia: Nature, mechanisms, and potential consequences","volume":"24","author":"Vaziri","year":"2004","journal-title":"Semin. Nephrol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1053\/j.ajkd.2003.10.037","article-title":"Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: The chronic renal impairment in Birmingham (CRIB) study","volume":"43","author":"Landray","year":"2004","journal-title":"Am. J. Kidney Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1681\/ASN.2012010017","article-title":"Loss of the Endothelial Glycocalyx Links Albuminuria and Vascular Dysfunction","volume":"23","author":"Salmon","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Seliger, S.L., Salimi, S., Pierre, V., Giffuni, J., Katzel, L., and Parsa, A. (2016). Microvascular endothelial dysfunction is associated with albuminuria and CKD in older adults. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0303-x"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wang, H.E., Shapiro, N.I., Safford, M.M., Griffin, R., Judd, S., Rodgers, J.B., Warnock, D.G., Cushman, M., and Howard, G. (2013). High-Sensitivity C-Reactive Protein and Risk of Sepsis. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0069232"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.jcrc.2012.11.002","article-title":"Inflammatory and endothelial activation biomarkers and risk of sepsis: A nested case-control study","volume":"28","author":"Wang","year":"2013","journal-title":"J. Crit. Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1164\/rccm.200506-888OC","article-title":"Preinfection Systemic Inflammatory Markers and Risk of Hospitalization Due to Pneumonia","volume":"172","author":"Yende","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1681\/ASN.2014101009","article-title":"Low Vitamin D and High Fibroblast Growth Factor 23 Serum Levels Associate with Infectious and Cardiac Deaths in the HEMO Study","volume":"27","author":"Chonchol","year":"2016","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00467-012-2336-0","article-title":"Beyond mineral metabolism, is there an interplay between FGF23 and vitamin D in innate immunity?","volume":"28","author":"Bacchetta","year":"2013","journal-title":"Pediatr. Nephrol."},{"key":"ref_43","unstructured":"Centers for Disease Control and Prevention (CDC) (2007). Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005. MMWR Morb. Mortal. Wkly. Rep., 56, 197\u2013199."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1080\/00365540600810026","article-title":"The epidemiology of and risk factors for invasive Staphylococcus aureus infections in western Sweden","volume":"39","author":"Jacobsson","year":"2007","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1159\/000168012","article-title":"Infection of hemodialysis catheters: Incidence and mechanisms","volume":"9","author":"Almirall","year":"1989","journal-title":"Am. J. Nephrol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1681\/ASN.V491719","article-title":"Successful use of cuffed central venous hemodialysis catheters inserted percutaneously","volume":"4","author":"Swartz","year":"1994","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_47","unstructured":"Centers for Disease Control and Prevention (CDC) (2002). Staphylococcus aureus resistant to vancomycin\u2014United States, 2002. MMWR Morb. Mortal. Wkly. Rep., 51, 565\u2013567."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/sdi.12094","article-title":"Multidrug-Resistant Organisms in Dialysis Patients","volume":"26","author":"Calfee","year":"2013","journal-title":"Semin. Dial."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/j.jiph.2020.01.314","article-title":"Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis","volume":"13","author":"Rteil","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1086\/424516","article-title":"Burden of infection in patients with end-stage renal disease requiring long-term dialysis","volume":"39","author":"Berman","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000058393","article-title":"Hospitalizations for Bacterial Endocarditis after Initiation of Chronic Dialysis in the United States","volume":"91","author":"Abbott","year":"2002","journal-title":"Nephron"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/1\/230\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T10:14:09Z","timestamp":1768817649000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/1\/230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,19]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["microorganisms14010230"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14010230","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,19]]}}}