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Abstract: PO1068

Temporal Trends in Clinical Phenotype, Bacterial Genotype, and Clinical Outcomes in Hemodialysis-Dependent Patients with Staphylococcus aureus Bacteremia

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sinclair, Matthew R., Duke University Hospital, Durham, North Carolina, United States
  • Souli, Maria, Duke University Hospital, Durham, North Carolina, United States
  • Ruffin, Felicia, Duke University Hospital, Durham, North Carolina, United States
  • Park, Lawrence, Duke Global Health Institute, Durham, North Carolina, United States
  • Dagher, Michael M., Duke University Hospital, Durham, North Carolina, United States
  • Wyatt, Christina M., Duke University Hospital, Durham, North Carolina, United States
  • Fowler, Vance, Duke University Hospital, Durham, North Carolina, United States
Background

Staphylococcus (S.) aureus bacteremia (SAB) is a common and potentially lethal infection among hemodialysis-dependent (HD) patients. The determinants of clinical outcomes in HD patients with SAB are not completely understood. We evaluated temporal trends in SAB-attributable mortality, metastatic infections, and bacterial genotype in HD patients over a 20-year period.

Methods

Hospitalized, non-neutropenic HD and non-HD adults with monomicrobial SAB were prospectively enrolled from Jan 1, 1995 to Dec. 31, 2015. Clinical characteristics, bacterial isolates, and outcome data were collected. Isolates were previously genotyped using spa typing. Differences between HD and non-HD patients were estimated using medians/quartiles or counts/percentages with statistical significance evaluated with Mann-Whitney-U or Fisher’s Exact test. Proportions of participants experiencing each outcome were calculated overall and by calendar year. Secular trends in proportions were estimated with linear regression and associations between bacterial genotypes, clinical characteristics, and clinical outcomes were estimated using univariate and multivariate logistic regression.

Results

Among 2,347 unique participants, 495 (21.1%) were HD. Compared to the non-HD patients, HD patients were younger (median 57 years (y) vs 60 y, p=0.002) and more likely to be Black (74.6% vs 26% p<0.001), female (48.1% vs 42.1% p=0.019), and to have diabetes (56.2% vs 33.8% p<0.001). HD patients experienced significant increases in the annual prevalence of age- and diabetes-adjusted SAB-attributable mortality (0.49% per year p=0.05), metastatic infections (0.79% per year p=0.028), and infection with the highly virulent Methicillin resistant strain USA300 (0.97% per year, p<0.001). The increase in USA300 infections did not appear to explain the observed increases in metastatic infections (Odds Ratio [OR] 1.33, Confidence Interval [CI] 0.55-3.21) or SAB-attributable mortality (OR 0.57, CI 0.14-2.32).

Conclusion

Clinical characteristics differed significantly between HD and non-HD patients with SAB. Increases in mortality and metastatic infections over time were not explained by the rise in more virulent strains of S. aureus, but may be partially explained by changes in patients’ characteristics.