Clinical Characteristics, Microbiology and Outcomes of Bloodstream Infections in Patients Undergoing Haemodialysis-An Australian Network Cohort Study.

Abstract

Aim: This study reviewed the morbidity and mortality of bloodstream infections (BSIs) in patients with kidney failure receiving haemodialysis (HD).

Methods: We conducted a retrospective cohort study reviewing clinical characteristics, microbiology and outcomes of BSIs in patients receiving HD from 1 December 2017 to 1 December 2023 using data from an integrated network of dialysis sites. Descriptive and regression analyses were conducted, as well as Kaplan-Meier analysis for survival.

Results: Of 1461 patients who received HD over the study period, 171 positive blood cultures occurred in 137 patients. Sixty blood cultures (35%) were considered non-significant contaminants, leaving 111 significant BSIs in 97 patients. Patients with BSIs had a median age of 65 years (interquartile range [IQR]: 50-76); 61% were males, with 48% having diabetes mellitus and 57% cardiovascular disease. A high proportion of BSI episodes (66/111, 59%) were determined to be HD access-associated, primarily in patients with central venous catheters (55/111, 50%). The most frequent non-HD access-associated sources were intra-abdominal/biliary (9%) and urinary (8%). Staphylococcus aureus (25%) was the most isolated organism, followed by Staphylococcus epidermis (12%). Polymicrobial BSI occurred in 10% of episodes. Median hospitalisation length was 9 days (IQR: 6-15). Mortality at 90 days was high (24%), and on multivariate analysis was associated with increasing age (odds ratio: 1.06 per year [IQR: 1.01-1.10]).

Conclusion: BSIs remain a major issue in patients receiving HD, contributing to prolonged hospitalisations and high mortality rates. HD access-associated BSIs account for a substantial proportion of BSIs and remain a pertinent target for intervention.