Increased risk of Staphylococcus aureus bacteremia in hemodialysis—A nationwide study
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Increased risk of Staphylococcus aureus bacteremia in hemodialysis—A nationwide study. / Chaudry, Mavish S.; Gislason, Gunnar H.; Kamper, Anne Lise; Rix, Marianne; Larsen, Anders R.; Petersen, Andreas; Andersen, Paal S.; Skov, Robert L.; Fosbøl, Emil L.; Westh, Henrik; Schønheyder, Henrik C.; Benfield, Thomas L.; Fowler, Vance G.; Torp-Pedersen, Christian; Bruun, Niels E.
I: Hemodialysis International, Bind 23, Nr. 2, 2019, s. 230-238.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Increased risk of Staphylococcus aureus bacteremia in hemodialysis—A nationwide study
AU - Chaudry, Mavish S.
AU - Gislason, Gunnar H.
AU - Kamper, Anne Lise
AU - Rix, Marianne
AU - Larsen, Anders R.
AU - Petersen, Andreas
AU - Andersen, Paal S.
AU - Skov, Robert L.
AU - Fosbøl, Emil L.
AU - Westh, Henrik
AU - Schønheyder, Henrik C.
AU - Benfield, Thomas L.
AU - Fowler, Vance G.
AU - Torp-Pedersen, Christian
AU - Bruun, Niels E.
PY - 2019
Y1 - 2019
N2 - Introduction: Staphylococcus aureus bacteremia (SAB) is a high-risk infection and feared complication related to hemodialysis. This study aimed to investigate incidence and risk factors for SAB depending on hemodialysis access type. Methods: The Danish National Registry on Regular Dialysis and Transplantation was used to identify patients from January 1, 1996 to December 31, 2011 with end-stage kidney disease. Patients were followed until death, the first episode of SAB, or end of study (December 31, 2011). Independent risk factors were assessed by multivariable Poisson regression with time-updated exposure variables. Findings: Total of 9997 patients were included. The initial modality of renal replacement therapy was hemodialysis in 6826 patients and peritoneal dialysis in 2882 patients; 289 patients had preemptive kidney transplantation. SAB occurred in 1278 patients (12.8%). The incidence rate of SAB declined after 90 days and leveled off after 270 days in hemodialysis, peritoneal dialysis, and kidney transplanted. As compared to peritoneal dialysis, the adjusted rate ratio (RR) for SAB was 7.42 (95% CI 5.63–9.79) in uncuffed central venous catheter (CVC), 5.68 (95% CI 4.39–7.36) in cuffed CVC, 4.43 (95% CI 2.10–9.53) in arteriovenous graft, and 3.40 (95% CI 2.79–4.15) in arteriovenous fistula. SAB risk did not differ between uncuffed and cuffed CVC. The risk of SAB was increased during the first three months of renal replacement therapy especially for CVC (RR 11.37 [95% CI7.09–18.22]) compared with peritoneal dialysis. Diabetes mellitus (RR 1.35 [95% CI 1.20–1.51]) and male sex (RR 1.15 [95% CI 1.03–1.29]) were also associated with SAB. Discussion: Patients on hemodialysis had a high incidence rate of SAB, particularly those undergoing hemodialysis via CVC. SAB risk was comparable for cuffed and uncuffed CVC. Diabetes mellitus, male sex, and the first three months in renal replacement therapy were independently associated with SAB.
AB - Introduction: Staphylococcus aureus bacteremia (SAB) is a high-risk infection and feared complication related to hemodialysis. This study aimed to investigate incidence and risk factors for SAB depending on hemodialysis access type. Methods: The Danish National Registry on Regular Dialysis and Transplantation was used to identify patients from January 1, 1996 to December 31, 2011 with end-stage kidney disease. Patients were followed until death, the first episode of SAB, or end of study (December 31, 2011). Independent risk factors were assessed by multivariable Poisson regression with time-updated exposure variables. Findings: Total of 9997 patients were included. The initial modality of renal replacement therapy was hemodialysis in 6826 patients and peritoneal dialysis in 2882 patients; 289 patients had preemptive kidney transplantation. SAB occurred in 1278 patients (12.8%). The incidence rate of SAB declined after 90 days and leveled off after 270 days in hemodialysis, peritoneal dialysis, and kidney transplanted. As compared to peritoneal dialysis, the adjusted rate ratio (RR) for SAB was 7.42 (95% CI 5.63–9.79) in uncuffed central venous catheter (CVC), 5.68 (95% CI 4.39–7.36) in cuffed CVC, 4.43 (95% CI 2.10–9.53) in arteriovenous graft, and 3.40 (95% CI 2.79–4.15) in arteriovenous fistula. SAB risk did not differ between uncuffed and cuffed CVC. The risk of SAB was increased during the first three months of renal replacement therapy especially for CVC (RR 11.37 [95% CI7.09–18.22]) compared with peritoneal dialysis. Diabetes mellitus (RR 1.35 [95% CI 1.20–1.51]) and male sex (RR 1.15 [95% CI 1.03–1.29]) were also associated with SAB. Discussion: Patients on hemodialysis had a high incidence rate of SAB, particularly those undergoing hemodialysis via CVC. SAB risk was comparable for cuffed and uncuffed CVC. Diabetes mellitus, male sex, and the first three months in renal replacement therapy were independently associated with SAB.
KW - hemodialysis access type
KW - renal replacement therapy
KW - Staphylococcus aureus bacteremia
U2 - 10.1111/hdi.12728
DO - 10.1111/hdi.12728
M3 - Journal article
C2 - 30779302
AN - SCOPUS:85061904810
VL - 23
SP - 230
EP - 238
JO - Hemodialysis International
JF - Hemodialysis International
SN - 1492-7535
IS - 2
ER -
ID: 216931162