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Abstract: TH-PO276

Rapid Incidence and Emergence of Catheter-Related Bloodstream Infections (CRBSIs) Among CVC-Dependent Hemodialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Massey, Kenneth, CorMedix Inc, Berkeley Heights, New Jersey, United States
  • Rajagopalan, Krithika, Anlitiks Inc., Dover, Massachusetts, United States
  • Seyedin, Roxanna, Anlitiks Inc., Dover, Massachusetts, United States
Background

Kidney failure patients receiving hemodialysis (HD) via a central venous catheter (CVC) are at high risk of developing catheter-related bloodstream infections (CRBSIs), resulting in increased mortality, hospitalizations, and long-term complications (LTCs). A claims-based algorithm was developed to assess real-world outpatient/inpatient (OP/IP) CRBSIs among CVC-dependent HD (CVC-HD) patients.

Methods

A retrospective analysis of merged data from United States Renal Data System (USRDS), CROWNWeb (dialysis orgs.), and Medicare claims (2013-2018) was conducted. Among incident CVC-HD (2014-2017) patients with 1 year pre- and ≥ 1-year post-index data (n=51,783), CRBSI incidence was the first date of OP/IP CRBSI occurrence. OP CRBSI was the first oral/intravenous antibiotic prescription within ±1 day of the first OP emergency/urgent care visit post-CVC insertion. IP CRBSI was the first occurrence of either sepsis/bacteremia and ICD-9/10 CMs 999.32, T80211x; 999.31, T80219x, T80218x claims or sepsis/bacteremia diagnosis without occurrence for pneumonia, gangrene, or urinary tract infections. CRBSI incidence proportion and rates, median days to CRBSI, proportion of CRBSIs at days 30 and 90, and 1-year post-CRBSI LTC rates were assessed

Results

The CVC-HD cohort’s mean age was 63 (SD:15.3); 47% (n=7,822) were female and 29% (n=4,898) were African American. CRBSI incidence proportion and rates were approximately 33% (n=16,813) and 4.5 per 1000-catheter days, respectively. In total 81% (n=13,559) of CRBSIs were diagnosed IP and 19% (n=3,254) were diagnosed in OP settings. Overall, 33% and 47% developed CRBSIs within 30- and 90-days post-CVC insertion, respectively. Median days to CRBSI were 107 days (interquartile range: 294 days). Frequently reported LTCs were HF (58%), dysrhythmia (54%), PVD (41%), stroke (17%), and MI (13%).

Conclusion

Of the 1/3rd of CVC-HD patients with CRBSIs, 33% and 47% developed CRBSI within 30- and 90-days post-CVC insertion, respectively. High rates of HF, PVD, stroke, and MI were reported 1-year post-CRBSI. Assessment of the incremental burden of clinical complications and costs associated with CRBSIs is warranted and underway. Early and high incident CRBSI rates underscore the importance of interventions that can prevent CRBSIs among CVC-HD patients.

Funding

  • Commercial Support –