Advanced trainee in Renal and General Medicine.
Staphylococcus Aureus Bacteraemia In Haemodialysis Patients In The Counties Manukau District Health Board From May 2014 To May 2017: Incidence, Risk Factors And Outcomes
Gleeson S, Devathasan J, Lam Po Tang M
Nephrology Department, Middlemore Hospital, Auckland
Aims: Staphylococcus Aureus (SA) Bacteraemia is a serious, relatively commonly encountered, infection in haemodialysis patients. Medical comorbidities, temporary or semi-permanent lines and regularly accessing the blood stream all contribute to infection. SA is notorious for seeding to distant areas and causing complications such as endocarditis.
We aimed to audit haemodialysis patients diagnosed with SA bacteraemia between May 2014 and May 2017 to assess the demographic, clinical and dialysis related characteristics, management and infection related outcomes.
Methods: Patients presenting with SA bacteraemia from May 2014 to May 2017 were identified from microbiology records. This was cross referenced with a departmentally collected record of access related infections and the concerto electronic medical record and the clinical vision renal database.
Results: 105 episodes of SA bacteraemia were identified in 80 patients. 76% of patients had a single episode. 35% were female, mean age was 54.7 +/- 13.9, 65% were pacific peoples, 30% were New Zealand Maori.
Diabetes was the cause of renal failure in 57.5%. Mean dialysis vintage was 44.6 +/- 53.2 months. 60% had a fistula at the time of infection, 39% had a tunnelled line.
In those with tunnelled lines, the documented reason they didn’t have a fistula were; medical decision (19%), suboptimal dialysis start (59%) and patient choice (9%).
81% of infections were due to methicillin sensitive SA. 61% of the infection episodes were directly related to the dialysis access, 10.5% were due to skin and soft tissue infections, 11.4% were due to bone infections and 4% were due to endocarditis. Of those dialysis access related infections 64% were due to tunnelled lines and 35% were due to fistulas. 93% had an echo and 83% had follow-up negative blood culture. 37% had an associated complication. 30-day mortality was 7.6%
Conclusions: SA bacteraemia remains a common problem in haemodialysis patients. It is often related to dialysis access and has a high rate of complications and mortality. Fistulas are the preferred dialysis access but even among those with fistulas SA bacteraemia remains a significant problem.
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