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.

Cannulation technique and complications in arteriovenous fistulas: a Swedish Renal Registry-based cohort study

“…In Sweden, the total infection-related mortality among patients in need of dialysis is 3% [ 30 ]. A study from the Netherlands, Canada, Norway, Spain, France, and Turkey reported a total infection mortality rate of 6% in the dialysis population [ 31 ], and a Danish study reported a total infection mortality rate of 4.1% [ 32 ]. The occurrence of interventions due to stenosis [ 33 ] and hemorrhage [ 28 ] also seems to be in the same magnitude as in previous studies, therefore we assume that the incidence of infections also has been reported to the same extent.…”

Incidence Trends and Epidemiology of Staphylococcus aureus Bacteremia: A Systematic Review of Population-Based Studies

“…One-third of SAB cases were device-related [ 30 ]; the increasing utilization of indwelling foreign devices including vascular catheters, and orthopedic prostheses in clinical practice is a well-established risk factor associated with SAB [ 40 ]. Also, patients undergoing hemodialysis have an increased SAB incidence rate, particularly when chronic indwelling vascular catheters are used for hemodialysis access [ 23 , 41 ].…”

Genetic Identification of Methicillin-Resistant Staphylococcus aureus Nasal Carriage and Its Antibiogram among Kidney Dialysis Patients at a Tertiary Care Hospital in AL-Karak, Jordan

“…Dialysis patients are highly susceptible to infections, frequently those caused by antimicrobial-resistant organisms, including MRSA [ 32 ]. In hemodialysis patients, the vascular access site in infections is closely associated to S. aureus bacteremia (SAB) [ 33 ]. Understanding and evaluating the bacterial infection sources, risk factors associated with it, and how the bacteria transmission occurs will be helpful in the planning to prevent and control the infections.…”