Abstract: PUB088
Getting to the Heart of the Matter: Increased Risk of Developing Infective Endocarditis Among Patients on Hemodialysis
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ghimire, Anukul, University of Calgary, Calgary, Alberta, Canada
- Westlund, Anika, University of Calgary, Calgary, Alberta, Canada
- Lewis, Ian Andrew, University of Calgary, Calgary, Alberta, Canada
- Tonelli, Marcello, University of Calgary, Calgary, Alberta, Canada
Background
There is limited data characterizing the rates of IE following episodes of bacteremia among HD patients across a wide range of microorganisms. We sought to assess the proportion of infective endocarditis (IE)) following bacteremia in an unselected cohort of HD patients, as compared to the non-dialysis population.
Methods
We did a retrospective cohort study of all adults in Calgary, Alberta with ≥ 1 positive blood isolates between January 1, 2006, and October 15, 2022 for the most prevalent microorganisms in the population (excluding coagulase negative staphylococcus). Physician claims data was used to identify patients receiving maintenance HD ≤ 3 weeks prior to the index blood culture isolate (defined as the first isolate of each species per patient in a 30-day period). IE was defined using International Classification of Disease codes as cases occurring ≤ 90 days after index isolate. We assessed the proportion of IE associated with bacteremia episodes and stratified by microorganism.
Results
There were 1498 and 22,683 episodes of bacteremia among participants receiving and not receiving maintenance HD. Staphylococcus aureus was the most common organism in the HD cohort (n= 659, 44%) whereas Escherichia coli was the most common among non-dialysis participants (n= 9,294, 41%). Across all bloodstream infections, participants on HD were more likely to develop IE vs non-dialysis participants (relative risk [RR] 3.96, 95% confidence interval [CI] 3.48-4.51) as shown in Figure 1. This increased risk was observed for all organisms except Enterococcus faecalis (RR 1.0, 95% CI 0.6-1.68), including those that are less commonly associated with IE such as Beta-hemolytic streptococcus (RR 4.09, 95% CI 2.64-6.34).
Conclusion
Patients receiving maintenance HD are at markedly increased risk of IE following bacteremia due to most pathogens. These findings have implications for risk-stratifying episodes of bacteremia in the HD population.
Funding
- Other U.S. Government Support