Abstract: SA-PO0447
Staphylococcus aureus-Induced Sepsis in the Dialysis Setting: Investigation of Vascular Access and Trends over Time Among Medicare Beneficiaries
Session Information
- Dialysis: Vascular Access
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Fuller, Sammantha B, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Wang, Dongyu, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Ferreira, Catia Matos, Vaccines and Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware, United States
- Taylor, Sylvia, Vaccines and Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
- Dube, Sabada, Vaccines and Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
- Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background
Bloodstream infections remain a significant complication in the US hemodialysis (HD) population, contributing to high morbidity and mortality. Vascular access type, particularly catheter use, is linked to elevated infection risk. Trends in Staphylococcus aureus (S. aureus) sepsis incidence and the impact of access type have not been fully evaluated in a large contemporary cohort.
Methods
Centers for Medicare & Medicaid Services data between 2016 and 2023 were used to assess S. aureus sepsis in adults receiving maintenance HD and covered by Medicare Fee-For-Service. S. aureus sepsis was identified using ICD-10 codes A4101 and A4102 (sepsis due to methicillin-susceptible and -resistant S. aureus, respectively). Incidence rates (IR) were calculated; events within 90 days were considered a single event. IRs were stratified by year, access type (catheter, arteriovenous [AV] fistula, AV graft), and demographics. Hospitalization days were summarized.
Results
Among 911,549 patients, 86,360 S. aureus sepsis events occurred over 2,129,422 patient-years (IR: 4.1 per 100 patient-years; 95% confidence interval [CI]: 4.0, 4.1). Methicillin-resistant and -sensitive S. aureus contributed roughly equally. Between 2016 and 2023, S. aureus sepsis rates declined, especially in catheter users (IRs [95% CI]: 2016, 11.6 [11.3, 12.0]; 2023, 8.6 [8.3, 8.9]), although, overall catheter use increased from 16% to 24%. Higher IRs were noted in males and younger patients, indicating potential disparities. Of the 86,360 sepsis events, 88.5% (76,428) were followed by a hospitalisation within 90 days of diagnosis. Average hospital stay was 14.1 days and 19.1 days within 30 and 90 days of diagnosis, respectively.
Conclusion
S. aureus sepsis remains a major complication in dialysis patients, especially among catheterized patients. Although catheter use increased over time, the rate of S. aureus sepsis decreased in this subgroup (potentially related to strict infection control protocols during the COVID-19 pandemic), leading to relatively stable overall IRs during the study period. These data highlight the continued challenge of S. aureus sepsis, underscoring the need for effective prevention of S. aureus infection and management strategies for patients on HD.
Funding
- Commercial Support – AstraZeneca