Outcomes of Staphylococcus aureus Infection in Hemodialysis-Dependent Patients

Abstract

Background and objectives: Staphylococcus aureus is a leading cause of infection in patients with ESRD. Clinical and economic outcomes associated with S. aureus bacteremia and other S. aureus infections in patients with ESRD were examined.Design, setting, participants, & measurements: Laboratory, clinical, and hospital billing data from a randomized trial of 3359 hemodialysis-dependent patients hospitalized with S. aureus infection in the United States whose vascular access type was fistula or graft and who were hospitalized with S. aureus infection to evaluate inpatient costs, hospital days, and mortality over 12 wk were used. Generalized linear regression was used to identify independent predictors of 12-wk costs, inpatient days, and mortality.Results: Of the 279 patients (8.3%) who developed S. aureus infection during approximately 1 yr of follow-up, 25.4% were treated as outpatients. Among patients for whom billing data were available, 89 patients hospitalized with S. aureus bacteremia incurred mean 12-wk inpatient costs of $19,454 and 11.9 inpatient days. Among the 70 patients hospitalized with non-bloodstream S. aureus infections, mean inpatient costs were $19,222 and the mean number of inpatient days was 11.3. Twelve-week mortality was 20.2 and 15.7% for patients with S. aureus bloodstream and non-bloodstream infections, respectively. Older age was independently associated with higher risk of death among patients with S. aureus bacteremia and with higher inpatient costs and more hospital days among patients with non-bloodstream infections.Conclusions: Hemodialysis-dependent patients with fistula or graft access incur high costs and long inpatient stays when hospitalized for S. aureus infection.

Phase IIa Study of the Immunogenicity and Safety of the Novel Staphylococcus aureus Vaccine V710 in Adults with End-Stage Renal Disease Receiving Hemodialysis

“…The most common infectious etiology is S. aureus (21). Patients infected with S. aureus frequently develop a wide range of serious complications, including dialysis site infections (often with resultant loss of access), infective endocarditis, and osteomyelitis, eventuating in substantial morbidity and mortality (4,12). S. aureus infections in patients on hemodialysis absorb substantial resources (2,4,15,19).…”

“…nfections account for almost 14% of deaths in patients with end-stage renal disease (ESRD) (2,4,12,15,19,21). As a result of the considerable morbidity, mortality, and economic toll of Staphylococcus aureus infections in dialysis patients, a well-tolerated S. aureus vaccine that provides long-term protection in ESRD patients may have a substantial public health impact (2,3,4,12,15,17,19,21).…”

Efficacy profile of a bivalent Staphylococcus aureusglycoconjugated vaccine in adults on hemodialysis: Phase III randomized study

“…4 In the United States, between one-third and one-half of S. aureus bacteremias in hemodialysis patients are due to multi-resistant S. aureus strains. 1,[4][5][6] Healthcare costs associated with S. aureus bacteremia in hemodialysis patients are substantial. 5 Complications include endocarditis, osteomyelitis, discitis and soft tissue abscesses, and the case fatality rate is as high as 20%.…”

“…1,[4][5][6] Healthcare costs associated with S. aureus bacteremia in hemodialysis patients are substantial. 5 Complications include endocarditis, osteomyelitis, discitis and soft tissue abscesses, and the case fatality rate is as high as 20%. 5,7 In hemodialysis patients the type of vascular access may predispose toward bacteremia, with higher rates of S. aureus bacteremia observed in patients with venous catheters in situ than in patients with arteriovenous fistulas.…”

DNA Microarray Genotyping and Virulence and Antimicrobial Resistance Gene Profiling of Methicillin-Resistant Staphylococcus aureus Bloodstream Isolates from Renal Patients

“…The study was carried out in Beaumont Hospital, Dublin, Ireland, an 820-bed tertiary referral center harboring the national referral center for renal and pancreatic transplantation and responsible for approximately 200 hemodialysis patients at any given time. Many studies have investigated the sources and outcomes of S. aureus bacteremia among renal patients; however, this is the first study, to our knowledge, to genetically characterize MRSA BSI isolates from renal patients (4,8,10).…”