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Abstract: PO1156

Incidence and Outcomes of Gram-Negative Bacteraemias in Haemodialysis Patients: 12-Year Single-Centre Experience

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Malik, Fatima, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Naito, Anna, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Bradwell, Lisa, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Cregg, Christopher Mark, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Makanjuola, David, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
Background

Patients on haemodialysis (HD) are at increased risk of contracting infections. Gram-negative bacteraemia in HD patients is associated with early mortality. In our HD population, we looked at the incidence and clinical outcomes of gram-negative bacteraemias over 12 years.

Methods

Data were collected from clinical records and the hospital’s microbiology database of all confirmed bacteraemias in HD patients between 2007 and 2018.

Results

283 episodes of gram-negative bacteraemia occurred in 1361 patients over the study period. 166 (58.7%) were male. The median age was 71 years (range 26-95).The proportion of gram-negative bacteraemias fell significantly between 2007 and 2010 and has plateaued since then. 90 (31.8%) had arteriovenous fistulae (AVF) or grafts, the remainder had dialysis lines, of which 41 (21.2%) had dual access (AVF or graft + line), with the AVF/graft not yet in use.

The bacteraemias were deemed to be access related in 89 events (31.4%). Of these, 73 (82.0%) were related to dialysis lines, 16 (18.0%) were related to AVF/graft. 190 (67.1%) were from other sources including urinary tract 18.4% (n=52), hepatobiliary 7.8% (n=22), chest 7.8% (n=22), gastro-intestinal 6.0% (n=17) and skin/soft tissue in 4.9% (n=14). There was no information on 4 patients (1.5%).

Complications of the bacteraemias included: discitis (6, 2.1%); osteomyelitis (5, 1.8%); endocarditis (2, 0.7%); septic arthritis (2, 0.7%); and death (34, 12.0%).

Conclusion

The incidence of gram-negative bacteraemias in our cohort appears to have plateaued, with bacteraemias originating from other sources such as the urinary tract and intra-abdominal accounting for a greater proportion of gram-negative bacteraemias in our cohort - a trend reflected in other similar observational studies in HD populations.

Dialysis lines remain a significant risk factor for bacteraemia, lending further weight to the importance of establishing early definitive vascular access. The increased incidence of pathogens from non-access related sources however, highlights that HD populations are exposed to both community and healthcare associated infections, and ongoing surveillance and strategies to reduce the burden of infections in this at-risk cohort remains imperative not just in dialysis centres, but also in the community