ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1101

Gram-Negative Bacteraemias in Haemodialysis Patients: Pathogen and Source Identification

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Naito, Anna, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
  • Malik, Fatima, 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
  • Bradwell, Lisa, 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

Gram-negative bacteraemia (GNB) in haemodialysis (HD) patients is associated with significant morbidity and mortality. Efforts to reduce rates of bacteraemias caused by Methicillin Resistant Staphylococcus Aureus have been hugely successful. Epidemiological studies now show the re-emergence of gram-negative pathogens, particularly Escherichia Coli (E.Coli) in causing bloodstream infections. We aimed to determine the source and pathogens responsible for GNB's in our HD cohort.

Methods

Data on all confirmed bacteraemias in HD patients between 2007 and 2018 were collected from clinical and electronic records from the hospital’s renal and microbiology databases.

Results

283 episodes of GNB occurred in 1361 patients over the 12-year period. 58.7% were male. The median age was 71 years (range 26-95). 31.8% had arteriovenous fistulae or grafts, the remainder had dialysis lines, of which 21.2% had dual access.

The organisms isolated are shown in table 1. E.Coli and Klebsiella Pneumoniae were the dominant pathogens, accounting for 40.6% and 15.9% of bacteraemias isolated respectively.

The most common sources of infection were HD access related in 31.4% (n=89) , urinary tract 18.4% (n=52) , hepato-biliary 7.8% (n=22), chest 7.8% (n=22), gastro-intestinal 6.0% (n=17), skin/soft tissue in 4.9% (n=14), other in 4.6% (n=13), no information on 4 patients (1.5%) and unknown source in 50 (17.7%).

Conclusion

E.Coli bacteraemias remain a major cause of GNB in our HD population. Dialysis lines are a significant risk factor for bacteraemia, lending further weight to the importance of establishing early definitive vascular access.

Resistance trends of gram-negative organisms are of particular and increasing concern. We have noticed changing sensitivity patterns of isolates and it is not clear whether local empiric antibiotic policy is contributing to selection pressures and antimicrobial resistance.

Table 1: Gram negative isolates from blood cultures
Organism%
Escherichia coli40.6
Klebsiella Pneumoniae15.9
Pseudomonas Aeruginosa7.8
Enterobacter spp7.8
Proteus mirabilis6.0
Serratia marcescens4.9
Other17