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

Abstract

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.

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

“…reported that the risk factors for morbidity and mortality among patients with BSI on hemodialysis were age, isolation of S. aureus , and isolation of a resistant microorganism [12]. …”

Would hemodialysis patients benefit from a Staphylococcus aureus vaccine?

“…7 As well as being common, these infections are potentially fatal; in patients on hemodialysis, the risk of death within 15 days of infection, or hospitalization for treatment of infection, is >8 times higher in SA-BSI than in BSI with other organisms. 8 The 90-day mortality for SA-BSI in this population is significant, reported between 18.2% and 30.6%. [9][10][11] The financial cost is also high, estimated at $25,518 per methicillin-resistant S aureus-BSI and $17,354 per methicillin-susceptible S aureus-BSI in patients on hemodialysis in the United States, 10 with similar costs reported in Europe.…”

Can bloodstream infection be predicted by nasal culture in hemodialysis patients?

“…In the United States, patients on hemodialysis had higher rates of bacteremia than peritoneal dialysis and 50% of patients experienced at least one episode of BSI [17]. Fram and colleagues reported an incidence of 42% for BSI in hemodialysis patients during six months (10) and other researchers reported the BSI rate at 0.52 per 1000 patient-days [18], which is much higher than the incidence of BSI in our study, which can re lect the appropriateness of preventive health measures taken in Pars hospital's dialysis center, including adequate governance structures, multidisciplinary team, and access to expert advice to consider CDC recommendation. Nevertheless, a multicentric study in Iran revealed serious negligence of health guidelines in hemodialysis centers [19], which con irms that the health care provided for hemodialysis patients severely affects the incidence of BSI in these patients and requires great attention.…”

“…In addition to the access-related infections, infection-related hospitalization of hemodialysis patients is associated with low albumin concentrations, immobility, and residence in a day care center [9]. In addition, Staphylococcus aureus in blood culture, and antibiotic resistance are important factors associated with greater risk of mortality and morbidity of BSI in hemodialysis patients [10]. Moreover, persistent nasal colonization with resistant S. aureus is suggested as an important risk factor associated with increased all-cause mortality rate [11].…”