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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

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.

Original language	English
Pages (from-to)	230-238
Number of pages	9
Journal	Hemodialysis International
Volume	23
Issue number	2
DOIs	https://doi.org/10.1111/hdi.12728
Publication status	Published - Apr 2019

Funding

Correspondence to: Mavish Safdar Chaudry, MD, Department of Cardiology, Gentofte Hospital, Post 635 Niels Andersens Vej 65, 2900 Hellerup, Denmark. E-mail: [email protected]. Conflict of Interest: VF received grants from NIH, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck, Medical Biosurfaces, Locus, Affinergy, Contrafect, Karius, and Centers for Disease Control; personal fees from Merck, Pfizer, Novartis, Galderma, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Byer, Theravance, Cubist, Basilea, Affinergy, Jenssen, Contrafect, xBiotech, Green Cross, Cubist, and UpToDate; pending patent: Sepsis Diagnostics, outside this work. Disclosure of grants or other funding: None.

Keywords

hemodialysis access type
renal replacement therapy
Staphylococcus aureus bacteremia
Bacteremia/etiology
Staphylococcal Infections/etiology
Humans
Risk Factors
Male
Staphylococcus aureus/pathogenicity
Kidney Failure, Chronic/complications
Renal Dialysis/adverse effects
Female
Aged

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10.1111/hdi.12728

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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{e2c479393ea3434c8816dc8bfda7e765,

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 = "hemodialysis access type, renal replacement therapy, Staphylococcus aureus bacteremia, Bacteremia/etiology, Staphylococcal Infections/etiology, Humans, Risk Factors, Male, Staphylococcus aureus/pathogenicity, Kidney Failure, Chronic/complications, Renal Dialysis/adverse effects, Female, Aged",

author = "Chaudry, \{Mavish S.\} and Gislason, \{Gunnar H.\} and Kamper, \{Anne Lise\} 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 = "John Wiley \& Sons Inc.",

number = "2",

}

Chaudry, MS, Gislason, GH, Kamper, AL, 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, vol. 23, no. 2, pp. 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 - hemodialysis access type

KW - renal replacement therapy

KW - Staphylococcus aureus bacteremia

KW - Bacteremia/etiology

KW - Staphylococcal Infections/etiology

KW - Humans

KW - Risk Factors

KW - Male

KW - Staphylococcus aureus/pathogenicity

KW - Kidney Failure, Chronic/complications

KW - Renal Dialysis/adverse effects

KW - Female

KW - Aged

UR - https://www.scopus.com/pages/publications/85061904810

U2 - 10.1111/hdi.12728

DO - 10.1111/hdi.12728

M3 - Article

C2 - 30779302

AN - SCOPUS:85061904810

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

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