Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study

Mavish S Chaudry; Gunnar H Gislason; Anne-Lise Kamper; Marianne Rix; Anders R Larsen; Andreas Petersen; Paal S Andersen; Robert L Skov; Emil L Fosbøl; Henrik Westh; Henrik C Schønheyder; Thomas L Benfield; Vance G Fowler; Christian Torp-Pedersen; Niels E Bruun

doi:10.1111/hdi.12728

Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study

Mavish S Chaudry, Gunnar H Gislason, Anne-Lise Kamper, Marianne Rix, Anders R Larsen, Andreas Petersen, Paal S Andersen, Robert L Skov, Emil L Fosbøl, Henrik Westh, Henrik C Schønheyder, Thomas L Benfield, Vance G Fowler, Christian Torp-Pedersen, Niels E Bruun

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Abstract

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.

Originalsprog	Engelsk
Tidsskrift	Hemodialysis International
Vol/bind	23
Udgave nummer	2
Sider (fra-til)	230-238
Antal sider	9
ISSN	1492-7535
DOI	https://doi.org/10.1111/hdi.12728
Status	Udgivet - apr. 2019

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10.1111/hdi.12728

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Citationsformater

Chaudry, M. S., Gislason, G. H., Kamper, A-L., Rix, M., Larsen, A. R., Petersen, A., Andersen, P. S., Skov, R. L., Fosbøl, E. L., Westh, H., Schønheyder, H. C., Benfield, T. L., Fowler, V. G., Torp-Pedersen, C., & Bruun, N. E. (2019). Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study. Hemodialysis International, 23(2), 230-238. https://doi.org/10.1111/hdi.12728

@article{029fde016669424db37db229cb8c9c0c,

title = "Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study",

abstract = "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.",

keywords = "Staphylococcus aureus bacteremia, hemodialysis access type, renal replacement therapy",

author = "Chaudry, {Mavish S} and Gislason, {Gunnar H} and Anne-Lise Kamper and Marianne Rix and Larsen, {Anders R} and Andreas Petersen and Andersen, {Paal S} and Skov, {Robert L} and Fosb{\o}l, {Emil L} and Henrik Westh and Sch{\o}nheyder, {Henrik C} and Benfield, {Thomas L} and Fowler, {Vance G} and Christian Torp-Pedersen and Bruun, {Niels E}",

note = "{\textcopyright} 2019 International Society for Hemodialysis.",

year = "2019",

month = apr,

doi = "10.1111/hdi.12728",

language = "English",

volume = "23",

pages = "230--238",

journal = "Hemodialysis International",

issn = "1492-7535",

publisher = "Wiley-Blackwell",

number = "2",

}

Chaudry, MS, Gislason, GH, Kamper, A-L, Rix, M, Larsen, AR, Petersen, A, Andersen, PS, Skov, RL, Fosbøl, EL, Westh, H, Schønheyder, HC, Benfield, TL, Fowler, VG, Torp-Pedersen, C & Bruun, NE 2019, 'Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study', Hemodialysis International, bind 23, nr. 2, s. 230-238. https://doi.org/10.1111/hdi.12728

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 - 2019/4

Y1 - 2019/4

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 - Staphylococcus aureus bacteremia

KW - hemodialysis access type

KW - renal replacement therapy

UR - http://www.scopus.com/inward/record.url?scp=85061904810&partnerID=8YFLogxK

U2 - 10.1111/hdi.12728

DO - 10.1111/hdi.12728

M3 - Journal article

C2 - 30779302

SN - 1492-7535

VL - 23

SP - 230

EP - 238

JO - Hemodialysis International

JF - Hemodialysis International

IS - 2

ER -

Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study

Abstract

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