Risk of Death After First-time Blood Stream Infection in Incident Dialysis Patients with Specific Consideration on Vascular Access and Comorbidity

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2018 Dec 22

PMID 30572826

Citations 14

Authors

Karl Emil Nelveg-Kristensen

Gunnar Hellmund Laier

James Goya Heaf

Affiliations

Soon will be listed here.

Abstract

Background: The mortality following blood stream infection (BSI) and risk of subsequent BSI in relation to dialysis modality, vascular access, and other potential risk factors has received relatively little attention. Consequently, we assessed these matters in a retrospective cohort study, by use of the Danish nation-wide registries.

Methods: Patients more than 17 years of age, who initiated dialysis between 1.1.2010 and 1.1.2014, were grouped according to their dialysis modality and vascular access. Survival was modeled in time-dependent Cox proportional hazard analyses. Potential risk factors confined by a modified Charlson comorbidity index (MCCI), were subsequently assessed in stepwise selection models.

Results: At baseline, 764 patients received peritoneal dialysis (PD), and 434, 479, and 782 hemodialysis (HD) patients were dialyzed by use of arteriovenous fistulas (AVFs), tunneled catheters (TCs), and non-tunneled catheters (NTCs), respectively. We identified 1069 BSIs with an overall incidence rate of 17.7 episodes per 100 person years, and 216 BSIs occurred more than one time in the same patient. HRs of post BSI mortality relative to PD were 3.20 (95% CI 1.86-5.50; p < 0.001) with NTCs; whereas no associations were found for AVF and TC. The risk of subsequent BSIs was higher with NTCs [HR 2.29 (95% CI 1.09-4.82), p = 0.030], and no significant difference was found for AVF and TC, in relation to PD. There was an increased risk of both outcomes with TC relative to AVF [death: 1.57 (95% CI 1.07-2.29, P < 0.021); BSI: 1.78 (95% CI 1.13-2.83, P < 0.014], and risk of death was reduced in patients who changed to AVF after first-time BSI. The MCCI was significantly associated with the risk of subsequent BSI and post BSI death; however, only some of the variables contained in the index were found to be significant risk predictors when analyzed in the fitted model.

Conclusions: While NTC was the most predominant risk factor for subsequent BSI and post BSI mortality, AVF appeared protective.

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References

Powe N, Jaar B, Furth S, Hermann J, Briggs W . Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int. 1999; 55(3):1081-90. DOI: 10.1046/j.1523-1755.1999.0550031081.x. View

Andersen T, Madsen M, Jorgensen J, Mellemkjoer L, Olsen J . The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull. 1999; 46(3):263-8. View

Saad T . Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis. 1999; 34(6):1114-24. DOI: 10.1016/S0272-6386(99)70018-1. View

Tanriover B, Carlton D, Saddekni S, Hamrick K, Oser R, Westfall A . Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int. 2000; 57(5):2151-5. DOI: 10.1046/j.1523-1755.2000.00067.x. View

Tokars J, Light P, Anderson J, Miller E, Parrish J, Armistead N . A prospective study of vascular access infections at seven outpatient hemodialysis centers. Am J Kidney Dis. 2001; 37(6):1232-40. DOI: 10.1053/ajkd.2001.24527. View

Angulo P . Nonalcoholic fatty liver disease. N Engl J Med. 2002; 346(16):1221-31. DOI: 10.1056/NEJMra011775. View

Jean G, Charra B, Chazot C, Vanel T, Terrat J, Hurot J . Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias. Nephron. 2002; 91(3):399-405. DOI: 10.1159/000064279. View

Ascher E, Hingorani A . The Dialysis Outcome and Quality Initiative (DOQI) recommendations. Semin Vasc Surg. 2004; 17(1):3-9. DOI: 10.1053/j.semvascsurg.2003.11.009. View

Foley R, Guo H, Snyder J, Gilbertson D, Collins A . Septicemia in the United States dialysis population, 1991 to 1999. J Am Soc Nephrol. 2004; 15(4):1038-45. DOI: 10.1097/01.asn.0000119144.95922.c4. View

10.

Allon M . Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004; 44(5):779-91. View

11.

Engemann J, Friedman J, Reed S, Griffiths R, Szczech L, Kaye K . Clinical outcomes and costs due to Staphylococcus aureus bacteremia among patients receiving long-term hemodialysis. Infect Control Hosp Epidemiol. 2005; 26(6):534-9. DOI: 10.1086/502580. View

12.

Nissenson A, Dylan M, Griffiths R, Yu H, Dean B, Danese M . Clinical and economic outcomes of Staphylococcus aureus septicemia in ESRD patients receiving hemodialysis. Am J Kidney Dis. 2005; 46(2):301-8. DOI: 10.1053/j.ajkd.2005.04.019. View

13.

Mokrzycki M, Zhang M, Cohen H, Golestaneh L, Laut J, Rosenberg S . Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant. 2006; 21(4):1024-31. DOI: 10.1093/ndt/gfi104. View

14.

Unver S, Atasoyu E, Evrenkaya T, Ardic N, Ozyurt M . Risk factors for the infections caused by temporary double-lumen hemodialysis catheters. Arch Med Res. 2006; 37(3):348-52. DOI: 10.1016/j.arcmed.2005.07.010. View

15.

Sedlacek M, Gemery J, Cheung A, Bayer A, Remillard B . Aspirin treatment is associated with a significantly decreased risk of Staphylococcus aureus bacteremia in hemodialysis patients with tunneled catheters. Am J Kidney Dis. 2007; 49(3):401-8. DOI: 10.1053/j.ajkd.2006.12.014. View

16.

Klevens R, Edwards J, Andrus M, Peterson K, Dudeck M, Horan T . Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)-data summary for 2006. Semin Dial. 2008; 21(1):24-8. DOI: 10.1111/j.1525-139X.2007.00379.x. View

17.

Li Y, Friedman J, ONeal B, Hohenboken M, Griffiths R, Stryjewski M . Outcomes of Staphylococcus aureus infection in hemodialysis-dependent patients. Clin J Am Soc Nephrol. 2009; 4(2):428-34. PMC: 2637588. DOI: 10.2215/CJN.03760708. View

18.

Collins A, Foley R, Herzog C, Chavers B, Gilbertson D, Ishani A . Excerpts from the US Renal Data System 2009 Annual Data Report. Am J Kidney Dis. 2010; 55(1 Suppl 1):S1-420, A6-7. PMC: 2829836. DOI: 10.1053/j.ajkd.2009.10.009. View

19.

Williams V, Quinn R, Callery S, Kiss A, Oliver M . The impact of treatment modality on infection-related hospitalization rates in peritoneal dialysis and hemodialysis patients. Perit Dial Int. 2010; 31(4):440-9. DOI: 10.3747/pdi.2009.00224. View

20.

Perl J, Wald R, McFarlane P, Bargman J, Vonesh E, Na Y . Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol. 2011; 22(6):1113-21. PMC: 3103730. DOI: 10.1681/ASN.2010111155. View