Bloodstream infections in patients with kidney disease: risk factors for poor outcome and mortality

Rojas, Loreto; Muñóz, Patricia; Kestler, Martha; Arroyo, David; Guembe, María; Rodríguez‐Créixems, Marta; Verde, Eduardo; Bouza, Emilio

doi:10.1016/j.jhin.2013.07.009

Cited by 34 publications

(23 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Theoretically, factors that could influence the outcome of nocardiosis include its presentation (eg, presence of cerebral abscesses [9]), possible coinfections with other opportunistic pathogens (eg, Aspergillus and cytomegalovirus [CMV] [6]), therapeutic modalities (eg, appropriateness of antibiotics according to species identification and antimicrobial susceptibility testing [2]), occurrence of adverse effects associated with antibiotics (eg, toxicity of trimethoprim-sulfamethoxazole [SXT] [6,10,11]), and presence of comorbidities [12]. An improved understanding of the impact of nocardiosis on outcomes after SOT and of factors associated with outcomes may help delineate a group of patients who require a specific initial diagnostic workup, treatment, and/or follow-up.…”

mentioning

confidence: 99%

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Lebeaux

Freund

Delden

et al. 2017

Clinical Infectious Diseases

View full text Add to dashboard Cite

Background. Solid organ transplant (SOT) recipients are at risk of nocardiosis, a rare opportunistic bacterial infection, but prognosis and outcome of these patients are poorly defined. Our objectives were to identify factors associated with 1-year mortality after nocardiosis and describe the outcome of patients receiving short-course antibiotics (≤120 days).Methods. We analyzed data from a multicenter European case-control study that included 117 SOT recipients with nocardiosis diagnosed between 2000 and 2014. Factors associated with 1-year all-cause mortality were identified using multivariable conditional logistic regression.Results. One-year mortality was 10-fold higher in patients with nocardiosis (16.2%, 19/117) than in control transplant recipients (1.3%, 3/233, P < .001). A history of tumor (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8), invasive fungal infection (OR, 1.3; 95% CI, 1.1-1.5), and donor age (OR, 1.0046; 95% CI, 1.0007-1.0083) were independently associated with 1-year mortality. Acute rejection in the year before nocardiosis was associated with improved survival (OR, 0.85; 95% CI, 0.73-0.98). Seventeen patients received short-course antibiotics (median duration 56 [24-120] days) with a 1-year success rate (cured and surviving) of 88% and a 5.9% risk of relapse (median follow-up 49 months).Conclusions. One-year mortality was 10-fold higher in SOT patients with nocardiosis than in those without. Four factors, largely reflecting general medical condition rather than severity and/or management of nocardiosis, were independently associated with 1-year mortality. Patients who received short-course antibiotic treatment had good outcomes, suggesting that this may be a strategy for further study.

show abstract

mentioning

confidence: 99%

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Lebeaux

Freund

Delden

et al. 2017

Clinical Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…In a university hospital in Spain, microorganisms isolated in blood cultures from patients with kidney disease were: Gram-negative bacteria, 52.3%; Gram-positive bacteria, 46.5%; and fungi, 1.2%. Escherichia coli was the most frequent microorganism (27%) [33]. …”

Section: Discussionmentioning

confidence: 99%

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

et al. 2015

View full text Add to dashboard Cite

BackgroundInfection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.MethodsRisk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.ResultsThere were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09).ConclusionsInfection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

show abstract

“…Rojas et al [24] conducted a retrospective cohort study in the nephrology department of a Spanish teaching hospital to evaluate the risk factors for mortality and other unfavorable outcomes in patients with BSI. Age was one of the risk factors associated with mortality (p = 0.02).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case–control study

et al. 2014

View full text Add to dashboard Cite

BackgroundInfection is the leading cause of morbidity and the second most frequent cause of mortality among patients on renal replacement therapy. A major morbid event in this population is hospitalization because of infection. The aim of this study was to investigate the risk factors for morbidity and mortality related to bloodstream infection (BSI) among patients on hemodialysis.ResultsRisk factors for morbidity and mortality related to BSI in patients on hemodialysis were investigated retrospectively by nested case–control, from January 2010 to June 2013. Patients were divided into two groups: those who progressed to hospitalization or death due to BSI (Group 1) and those who developed BSI, but did not progress to the same outcome (Group 2). Data were collected through consultation of patient records. For statistical analysis, logistic regression was used. There were 32 patients in Group 1 and 61 in Group 2. Logistic regression verified that, for each year of age, the chance of death or hospitalization for BSI increased 1.05 times [95% confidence interval (CI): 1.02–1.09]. Patients with BSI caused by Staphylococcus aureus had an 8.67 times higher chance of progressing to death or hospitalization (95% CI: 2.5–30.06). The isolation of multiresistant microorganisms in blood cultures of hemodialysis patients increased morbidity and mortality by 2.75 times (95% CI: 1.01–7.48).ConclusionIndependent risk factors for morbidity and mortality among patients after developing BSI during hemodialysis were: age, blood culture positive for S. aureus, and antibiotic resistance. Control measures to prevent microbial dissemination, primarily the multiresistant ones, should be intensified in this population. More studies are needed to standardize specific measures not yet classically standardized, such as collection of surveillance culture samples, contact precautions, and decolonization.

show abstract

Bloodstream infections in patients with kidney disease: risk factors for poor outcome and mortality

Cited by 34 publications

References 49 publications

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case–control study

Contact Info

Product

Resources

About