Bacteremia in Hemodialysis and Peritoneal Dialysis Patients

Wang, I‐Kuan; Chang, Yen Jung; Liang, Ching‐Chung; Chuang, Feng‐Rong; Chang, Chiz‐Tzung; Lin, Hsin‐Hung; Lin, Chung‐Chih; Yen, Tzung‐Hai; Lin, Pin Wen; Huang, Chiu‐Ching; Tsai, Wen‐Chen; Chen, Jinhua

doi:10.2169/internalmedicine.51.7111

Cited by 37 publications

(40 citation statements)

References 19 publications

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“…10,25,26 In a retrospective case series of 898 patients, Wang et al analysed 366 hemodialysis and 532 peritoneal dialysis patients with 191 episodes of bacteremia during 2003-2008 at a single hospital. 27 Similar to our current data, they found a higher incidence rate of bacteremia in hemodialysis than in peritoneal dialysis. However, patients were censored at switch in treatment modality, at transplantation, and at change in dialysis affiliation.…”

Section: Discussionsupporting

confidence: 91%

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

Chaudry

Gislason

Kamper

et al. 2019

Hemodialysis International

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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.

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Section: Discussionsupporting

confidence: 91%

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

Chaudry

Gislason

Kamper

et al. 2019

Hemodialysis International

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“…To capture infectious complications in the period of highest risk, we analyzed time to first bacteremia in a composite primary outcome. We observed a significantly shorter time to first bacteremia, technique failure, or death in patients with a CVC after correcting for comorbid status and diabetes, factors previously reported as significant in dialysis patients …”

Section: Discussionsupporting

confidence: 54%

“…We observed a significantly shorter time to first bacteremia, technique failure, or death in patients with a CVC after correcting for comorbid status and diabetes, factors previously reported as significant in dialysis patients. [12][13][14] This is the first direct comparison of infection risk with permanent vascular access vs. CVCs in NHHD. Our analysis indicates that CVC access is a significant risk factor for bacteremia in NHHD, an association that is well documented in patients receiving CHD.…”

Section: Discussionmentioning

confidence: 98%

Vascular access‐related infection in nocturnal home hemodialysis

Hayes

Tennankore

Battistella

et al. 2014

Hemodialysis International

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Frequent hemodialysis is associated with increased vascular access adverse events. We hypothesized that bacteremia would be more frequent in patients with central venous catheter (CVC) than arteriovenous fistula or arteriovenous graft (AVF/AVG) in nocturnal home hemodialysis (NHHD). We reviewed blood culture reports and concurrent clinical data for a cohort of one hundred eighty-seven NHHD patients between January 1, 2006 and June 30, 2012. The primary outcome was time to first bacteremia, technique failure, or death after commencing NHHD. Types of bacteremia and clinical consequences were analyzed. Analyses were adjusted for a priori defined confounders. One hundred eighty-seven patients were included with a total follow up of six hundred five patient years. Initial vascular access was AVF in seventy-eight (42%) patients, AVG in eleven (6%) patients, and CVC in ninety-eight (52%) patients. A total of 79.3% of patients with a CVC reached the composite endpoint of bacteremia, technique failure, or death in the study period; 44.5% of patients with an AVF or AVG reached this composite endpoint. Adjusted time to first bacteremia, technique failure, or death was significantly shorter in patients with initial CVC access (hazard ratio 2.42, 95% confidence interval 1.50-3.90, p < 0.001). Risk factors for bacteremia were comorbid status quantified by the Charlson Comorbidity Index (p < 0.001) and diabetes (p < 0.001). Coagulase negative staphylococcus was the commonest organism cultured accounting for 51.4% bacteremias. The second commonest organism was staphylococcus aureus (20.3% bacteremias). Patients undergoing NHHD with a CVC have a shorter duration to first infection, technique failure, or death than those with permanent vascular access.

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“…Vascular access was a major risk factor for infection and bacteremia, and the most common micro‐organism was Staphylococcus aureus in HD patients. HD patients with S. aureus bacteremia are known to be at notable risk for endocarditis, which is a life‐threating infectious disease . Other potential risk factors for infection include high burden of coexisting illnesses, hypoalbuminemia, immunosuppressive therapy, nephrotic syndrome, uremia, anemia, malnutrition and change of susceptibility of bacteria to antibiotics .…”

mentioning

confidence: 99%

Involvement of p38MAPK in Impaired Neutrophil Bactericidal Activity of Hemodialysis Patients

et al. 2018

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Mortality from infections has been reported to be higher in hemodialysis (HD) patients. Although dysfunction of neutrophils against bacterial infection was reported in HD patients, the precise mechanism remains to be clarified. We therefore examined the impacts of neutrophil inflammatory signaling on bactericidal activity in HD patients. Comprehensive analyses of intracellular signalings were performed in whole blood of HD patients and control using a microarray system. To confirm the contribution of the signaling to bactericidal activity in neutrophils, we examined the phosphorylation, bacterial killing function, reactive oxygen species (ROS) production, and myeloperoxidase (MPO) release in neutrophils against Staphylococcus aureus. RNA microarray analysis showed the suppression of p38 mitogen activated protein kinase (MAPK) signaling in HD patients. Neutrophils in HD patients showed the impairment of bactericidal activity against S. aureus compared to healthy subjects. Phosphorylation rate of p38MAPK of neutrophils in response to S. aureus was lower in HD patients than healthy subjects. The levels of ROS produced by neutrophils after co-culture with S. aureus were lower in HD patients, on the other hand, there was no difference of MPO release between HD patients and healthy subjects. A selective pharmacological inhibitor of p38MAPK suppressed bacterial killing function as well as ROS production in neutrophils of healthy subjects. Impairment of p38MAPK signaling pathway might contribute to the suppression of neutrophil bactericidal activity in HD patients through less production of ROS.

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Bacteremia in Hemodialysis and Peritoneal Dialysis Patients

Cited by 37 publications

References 19 publications

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

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

Vascular access‐related infection in nocturnal home hemodialysis

Involvement of p38MAPK in Impaired Neutrophil Bactericidal Activity of Hemodialysis Patients

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