Kidney Week

Abstract: TH-PO900

Dialysis Access and Risk of Staphylococcus aureus Bacteremia – A Nationwide Study

Session Information

• Dialysis: Infection
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 610 Dialysis: Infection

Authors

• Chaudry, Mavish, Department of Cardiology, Copenhagen, Denmark

Mavish Chaudry,

• Gislason, Gunnar, Gentofte Hospital, Copenhagen, Denmark

Gunnar Gislason,

• Kamper, Anne-Lise, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

Anne-Lise Kamper,

• Rix, Marianne, Rigshospitalet, Copenhagen, Denmark

Marianne Rix,

• Andersen, Paal Skytt, Statens Serum Institut, Copenhagen S, Denmark

Paal Skytt Andersen,

• Westh, Henrik, Hvidovre hospital, Hvidovre, Denmark

Henrik Westh,

• Schønheyder, Henrik Carl, Aalborg University Hospital, Aalborg, Denmark

Henrik Carl Schønheyder,

• Torp-Pedersen, Christian, Aalborg University Hospital, Aalborg, Denmark

Christian Torp-Pedersen,

• Bruun, Niels Eske, Herlev-Gentofte Hospital, Hellerup, Denmark

Niels Eske Bruun,

Background

Staphylococcus aureus bacteremia (SAB) is a high-risk infection. This study aimed to investigate incidence and risk factors of SAB with various modalities of dialysis.

Methods

The end-stage renal disease population was retrieved from The National Registry on Regular Dialysis and Transplantation, in the period from January 1^st 1996 to December 31^st 2011. Information on SAB was obtained from the nationwide SAB Database. Patients were followed until death, the first episode of SAB, end of study (December 31^st 2011), or a maximum of 16 years of follow-up. Independent risk factors were assessed by multivariable Cox regression.

Results

In the study period, 9997 patients commenced renal replacement therapy. The initial modality was hemodialysis in 6826, peritoneal dialysis in 2882 and 289 patients had a pre-emptive kidney transplantation. Changes in renal replacement therapy modality and vascular access was identified and entered time-updated during follow-up, allowing for time-updated exposure. SAB was found in 1278 patients (12.8%). The incidence rate of SAB was highest in uncuffed central venous catheter (CVC) (10.20/100 person-years) followed by cuffed CVC (9/100 person-years), arteriovenous graft (4.98/100 person-years) and arteriovenous fistula (4.93/100 person-years). The adjusted hazard ratio for SAB was: in cuffed CVC, 5.77 (95% CI 4.45-7.49), in uncuffed CVC, 7.13 (95% CI 5.39-9.42), in arteriovenous graft, 4.54 (95% CI 2.11-9.77) and in arteriovenous fistula, 3.40 (95% CI 2.78-4.14) compared to peritoneal dialysis. There was no difference in risk of SAB between uncuffed- and cuffed CVC. The first 1.5 months in renal replacement therapy in particular in CVC, diabetes mellitus and male gender were additional risk factors of SAB.

Conclusion

Patients in hemodialysis have a high incidence of SAB, in particular with CVC. In this study, the risk of SAB was similar in cuffed- and uncuffed CVC. The first 1.5 months in renal replacement therapy in particular in CVC, diabetes mellitus and male gender were independent risk factors of SAB.