Abstract: PO1023
Catheter-Related Bloodstream Infection Incidence and Associated Mortality Risk: Analysis of Merged USRDS-Medicare Claims
Session Information
- Vascular Access Arena: Challenges, Progress, and Prospects
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Massey, Kenneth, Cormedix, Berkeley Heights, New Jersey, United States
- Rajagopalan, Krithika, Anlitiks Inc, Dover, Massachusetts, United States
- Rajagopalan, Srinivasan, Anlitiks Inc, Dover, Massachusetts, United States
- Grossman, Aaron, Anlitiks Inc, Dover, Massachusetts, United States
- Chew, Paul, Cormedix, Berkeley Heights, New Jersey, United States
Background
Despite policy and provider initiatives, nearly 80% of end-stage-renal-disease (ESRD) patients initiate hemodialysis (HD) with a central venous catheter (CVC). However, CVCs may elevate risk of catheter hub contamination resulting in catheter-related blood stream infections (CRBSIs) and potentially serious consequences. This analysis aims to estimate the incidence, risk, and associated mortality of CRBSIs among CVC-dependent HD patients in the US.
Methods
A propensity score matched case-control analysis of 2013-2017 linked data from the United States Renal Data System (USRDS), dialysis organizations (i.e., CROWNWeb), and Medicare claims was conducted. Occurrence of CRBSI and associated mortality among incident CVC-dependent HD patients between 2014-2016 with a 1-year pre- and ≥1-year post-index were assessed. CRBSI case group index date was the first date of occurrence of any of the following post CVC insertion: ICD-9/10-CM 999.32, T80211x; 999.31, T80219x, T80218x and sepsis/bacteremia diagnosis within ±3 days of hospitalization; sepsis/bacteremia diagnosis without occurrence for pneumonia, gangrene, or urinary tract infections within ±3 days of hospitalization. Non-CRBSI control group was identified by an assigned index date (i.e., CVC insertion date + median days to CRBSI reported in CRBSI-case group). Frequency, mean, median, and chi-square and t-tests assessed group differences. Adjusted cox proportional hazards models examined time to CRBSI and time to mortality post CRBSI.
Results
Of the 55,727 CVC-dependent HD patients (mean age 67.8, 45% female), nearly 29% (n=15,882) developed a CRBSI (median time, 69 days); 54% (n=8,393), 67% (n= 10,327), and 80% (n=12,705) occurred within 90, 180 and 365 days of CVC insertion, respectively. After CRBSI occurrence, 40% and 50% died within 60 days and 180 days, respectively. CRBSI patients also had a significantly lower median survival (25.1 vs. 37.3 months) compared to non-CRBSI patients [hazard ratio: 0.74, 95% CI: 0.71-0.76].
Conclusion
CRBSIs occur in a third of CVC-dependent HD patients, with over half of the initial infections occurring within 90 days of CVC insertion. Patients with CRBSI had a higher risk of death compared to patients without CRBSI; with a 40% mortality within 60 days post-CRBSI.
Funding
- Commercial Support –