The epidemiology of haemodialysis catheter infections in Australia, 2016–20: a prospective cohort study

Objectives

To investigate the epidemiology in Australia of catheter-related infections in a national cohort of adults with kidney failure with incident haemodialysis central venous catheters (CVCs).

Study design

Cohort study nested within a cluster-randomised trial (REDUcing the burden of dialysis Catheter Complications, REDUCCTION); analysis of prospectively collected trial data, linked with Australian and New Zealand Dialysis and Transplant (ANZDATA) registry and state hospitalisations data.

Setting

Thirty-four health services in Australia (excluding Western Australia) that provide chronic haemodialysis and participated in the REDUCCTION trial.

Participants

Adults (18 years or older) with chronic kidney failure who received incident haemodialysis CVCs during 20 December 2016 – 31 March 2020.

Main outcome measures

Hospitalisation with any haemodialysis CVC infection; haemodialysis CVC-related bloodstream infections reported during the trial and verified by an independent panel.

Results

Our analysis included 3943 adults with chronic kidney failure; their mean age was 60.4 years (standard deviation, 15.5 years); 1556 were women (39.5%) and 485 were Aboriginal or Torres Strait Islander people (12.3%). Catheter-related infections were coded for 644 hospitalisations (24.5 per 100 patient-years; 95% confidence interval [CI], 22.6–26.4 per 100 patient-years); the incidence was higher among people under 55 years of age (adjusted incidence rate ratio [IRR], 1.55; 95% CI, 1.21–1.98) and those aged 55–70 years (adjusted IRR, 1.34; 95% CI, 1.05–1.70) than among people over 70 years of age. Community-onset haemodialysis catheter-related bloodstream infections were responsible for 159 hospitalisations (8.2% of 1938 infection-related hospitalisations); 57 of 650 infection-related hospitalisations of people under 55 years of age (8.8%), 62 of 640 of people aged 55–70 years (9.7%), and 40 of 648 of people over 70 years of age (6.2%). The median length of hospital stay with community-onset haemodialysis CVC-related bloodstream infections was ten days (interquartile range, 5–15 days), metastatic spread of infection was detected in twelve cases (7.5%), and four people died in hospital (2.5%); 40 removed haemodialysis CVCs did not require replacement. Nineteen of 121 hospitalisations for which the information was available included intensive care unit admissions (15.7%; median stay, 2.7 days; IQR, 1.1–4.6 days). The risk of haemodialysis CVC-related Staphylococcus aureus bloodstream infection declined with age (relative risk ratio, 0.65 per decade; 95% CI, 0.47–0.89).

Conclusions

The health burden of haemodialysis CVC infections in Australia is substantial, particularly among adults under 70 years of age.