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Meng L, Ng JJ, Choong AMTL, Dharmaraj RB, Menon R, Wong JCL, Ching S, Wong YF, Kong J, Ho P. Effectiveness of a native vein arteriovenous fistula tracking system. Semin Dial 2024; 37:161-171. [PMID: 37748774 DOI: 10.1111/sdi.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/30/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE This study aims to evaluate the effectiveness of a tracking program on the functional maturation rate of arteriovenous fistula (AVF). METHODS Two major clinical outcomes (commencement of cannulation and functional maturation) of created AVFs were compared between two cohorts. (i) Cohort 1: historical cohort; (ii) Cohort 2: AVFs created after implementation of the tracking project. Multivariable Cox regression models were used to assess the association between cohort allocation and the two major clinical outcomes. RESULTS Data of 114 and 141 patients were analyzed respectively from Cohorts 1 (historical data) and 2 (with AVF tracking). After adjustment of covariates in the multivariable analysis, the AVFs created in Cohort 2 were more likely to be cannulated earlier (adjusted HR: 2.82; 95% CI: 1.97-4.05; p < 0.001), compared to those in Cohort 1. Similarly, the AVFs of Cohort 2 patients had significantly higher probability of functional maturation (adjusted HR: 1.81; 95% CI: 1.31-2.48; p < 0.001) than fistulas in Cohort 1. Cannulation was commenced for half of the AVFs by 4.1 months post-creation in the historical cohort (Cohort 1), whereas in the post-tracking cohort, 50% of the AVFs were cannulated by 2.3 months after creation (p < 0.001). It took 5.5 and 4.3 months for 50% of the AVFs created in Cohort 1 and Cohort 2 patients to achieve catheter-free functional maturation, respectively (p = 0.06). CONCLUSION An AVF tracking program with maturation target for the access surgeons, together with a standardized tracking, feedback, and clinical strategy adjustment system is able to improve the AVF functional maturation rate.
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Affiliation(s)
- Lingyan Meng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Jun Jie Ng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Andrew Mark Tze Liang Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Rajesh Babu Dharmaraj
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Raj Menon
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Julian Chi Leung Wong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Susan Ching
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Yen Feng Wong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Jaqueline Kong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Pei Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
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Ho P, Binte Taufiq Chong Ah Hoo NNF, Cheng YX, Meng L, Chai Min Shen D, Teo BW, Ma V, Hargreaves CA. The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis. J Vasc Access 2024; 25:71-81. [PMID: 35543398 DOI: 10.1177/11297298221095769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD. METHOD Data of patients newly commenced on HD between July 2015 and June 2016 were reviewed. Patients were grouped by their VA format: (A) pre-emptive surgically created VA (SCVA), (B) tunneled central venous catheter (CVC) followed by SCVA creation, (C) long-term tunneled CVC only. Clinical events, number of investigations and procedures, hospital admissions, and incurred costs of the three groups were compared. RESULTS In the multivariable analysis, the cost incurred by the group A patients had no significant difference to that incurred in the group B patients (p = 0.08), while the cost of group C is significantly lower (p < 0.001). Both the 62.7% of group A with successful SCVA who avoided tunneled CVC usage, and those with a functionally matured SCVA in group B (66.1%), used fewer healthcare resources and incurred less cost for their access compared to those did not (p = 0.01, p = 0.02, respectively) during the first year of HD. CONCLUSION With comparable cost, a pre-emptive approach enables avoidance of tunneled CVC. Tunneled CVC only access format incurred lower cost and is suitable for carefully selected patients. Successful maturation of SCVA greatly affects patients' clinical journey and healthcare cost.
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Affiliation(s)
- Pei Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore
| | | | - Yi Xin Cheng
- Department of Statistics and Data Science, Faculty of Science, National University of Singapore, Singapore
| | - Lingyan Meng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Boon Wee Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Valerie Ma
- Division of Nephrology, Department of Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Carol Anne Hargreaves
- Department of Statistics and Data Science, Faculty of Science, National University of Singapore, Singapore
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Genetic Identification of Methicillin-Resistant Staphylococcus aureus Nasal Carriage and Its Antibiogram among Kidney Dialysis Patients at a Tertiary Care Hospital in AL-Karak, Jordan. Int J Microbiol 2023; 2023:9217014. [PMID: 36970126 PMCID: PMC10033209 DOI: 10.1155/2023/9217014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a major bacterial pathogen. Aim. The present study aimed to determine the incidence of MRSA infections among kidney dialysis patients and the antibiotic susceptibility patterns and investigate the prevalence of mecA gene among MRSA isolates. Materials and Methods. A total of 83 nasal sterile cotton swabs samples were obtained from hemodialysis patients from Al-Karak Governmental Hospital, Al-Karak, Jordan. Collected and cultured on nutrient agar and mannitol salt agar and incubating at 37°C for 24–48 hours, Staphylococcus aureus (S. aureus) strains were identified by gram stain, coagulase test, and catalase tests. The MRSA isolates were tested for the presence of MecA and SCCmec genes using the Xpert SA Nasal Complete assay real-time PCR. Factors such as age and gender were included in the study. The antibiotic profile tested by using the disc diffusion method tested all MRSA isolates. Results. This study showed that 10.8% of the cultures’ growth was S. aureus and 9.6% of all the patients were infected with MRSA, with no relationship between the number and frequency of MRSA according to the patient’s gender or age. All MRSA (100%) isolates have both genes (MecA genes and SCCmec genes), and all samples were resistant to oxacillin, ceftazidime, cefoxitin, aztreonam, and ampicillin. Conclusion. The MRSA prevalence was determined among kidney dialysis patients in the hospital. All positive samples were resistant to oxacillin, ceftazidime, cefoxitin, aztreonam, and ampicillin, which is a very rare finding, and this will give the scientists and doctors a dangerous indication about health-care centers in the Al-Karak city of Jordan.
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Yanık-Yalçın T, Erol Ç, Demirkaya MH, Durukan E, Kurt-Azap Ö. Evaluation of Clinical Approach and Outcomes Staphylococcus aureus Bacteremia. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:31-39. [PMID: 38633900 PMCID: PMC10986690 DOI: 10.36519/idcm.2023.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 04/19/2024]
Abstract
Objective Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacteremia (SAB) is still associated with a high mortality rate. This study aims to evaluate the clinical features and approaches to SAB and to analyze the parameters that may affect 7-day and 30-day mortality. Materials and Methods Adult patients with SAB data between 2011 and 2018 were evaluated retrospectively. Clinical data, patient demographics, and 7-day and 30-day mortality rates were obtained from their medical records. Results In total, 144 patients were included in the study; 57.6% (83/144) of patients were men, and the mean age was 65.2±16.5 years. The most common source of infection was the central-line catheter (38.9%), followed by intra-abdominal (21%), respiratory (16.7), infective endocarditis (5.6%), and osteoarticular foci (2.1%). Fifteen percent (15%) of the strains were methicillin resistant. Transthoracic echocardiography (TTE) was performed for 80.6% (116/144) patients. Infectious diseases specialist consultation within 96 hours from blood culture signal was requested in 79.9%. Overall, 7-day mortality was 11.8%, and 30-day mortality was 21.5%. Staying in intensive care units (ICU) increased the risk of 30-day mortality by 1.1 times, and respiratory-focused SAB increased the risk by 4.3 times. Conclusion SAB is still a big threat. Staphylococcal pneumonia remains a severe infection. Several prognostic factors influence mortality. Identifying the source, ensuring source control, and appropriate initial therapy as soon as possible are critical for reducing mortality and morbidity in SAB.
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Affiliation(s)
- Tuğba Yanık-Yalçın
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Çiğdem Erol
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Melike Hamiyet Demirkaya
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Elif Durukan
- Department of Public Health, Başkent University School of Medicine, Ankara, Turkey
| | - Özlem Kurt-Azap
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
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Hindy JR, Quintero-Martinez JA, Lee AT, Scott CG, Gerberi DJ, Mahmood M, DeSimone DC, Baddour LM. Incidence Trends and Epidemiology of Staphylococcus aureus Bacteremia: A Systematic Review of Population-Based Studies. Cureus 2022; 14:e25460. [PMID: 35774691 PMCID: PMC9239286 DOI: 10.7759/cureus.25460] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives: To determine incidence trends of Staphylococcus aureus bacteremia (SAB) from population-based studies from multiple countries. Methods: A contemporary systematic review was conducted using Ovid Cochrane Central Register of Controlled Trials (1991+), Ovid Embase (1974+), Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE) (1946+ including epub ahead of print, in-process & other non-indexed citations), and Web of Science Core Collection (Science Citation Index Expanded 1975+ and Emerging Sources Citation Index 2015+). Two authors (J.R.H. and J.A.Q.M.) independently reviewed all studies and included those that reported population-based incidence of SAB in patients aged 18 years and older. Results: Twenty-six studies met inclusion criteria with the highest number (n=6) of studies conducted in Canada. The incidence of SAB ranged from 9.3 to 65 cases/100,000/year. The median age of patients with SAB ranged from 62 to 72 years and SAB cases were more commonly observed in men than in women. The most common infection sources were intravascular catheters and skin and soft tissue infections. SAB incidence trends demonstrated high variability for geographic regions and calendar years. Overall, there was no change in the incidence trend across all studies during the past two decades. Conclusion: Multiple factors, both pros, and cons are likely responsible for the overall stable SAB incidence in countries included in this systematic review. Some of these factors vary in geographic location and prompt additional investigations from countries not included in the current review so that a more global characterization is defined.
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Steiger S, Rossaint J, Zarbock A, Anders HJ. Secondary Immunodeficiency Related to Kidney Disease (SIDKD)-Definition, Unmet Need, and Mechanisms. J Am Soc Nephrol 2022; 33:259-278. [PMID: 34907031 PMCID: PMC8819985 DOI: 10.1681/asn.2021091257] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kidney disease is a known risk factor for poor outcomes of COVID-19 and many other serious infections. Conversely, infection is the second most common cause of death in patients with kidney disease. However, little is known about the underlying secondary immunodeficiency related to kidney disease (SIDKD). In contrast to cardiovascular disease related to kidney disease, which has triggered countless epidemiologic, clinical, and experimental research activities or interventional trials, investments in tracing, understanding, and therapeutically targeting SIDKD have been sparse. As a call for more awareness of SIDKD as an imminent unmet medical need that requires rigorous research activities at all levels, we review the epidemiology of SIDKD and the numerous aspects of the abnormal immunophenotype of patients with kidney disease. We propose a definition of SIDKD and discuss the pathogenic mechanisms of SIDKD known thus far, including more recent insights into the unexpected immunoregulatory roles of elevated levels of FGF23 and hyperuricemia and shifts in the secretome of the intestinal microbiota in kidney disease. As an ultimate goal, we should aim to develop therapeutics that can reduce mortality due to infections in patients with kidney disease by normalizing host defense to pathogens and immune responses to vaccines.
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Affiliation(s)
- Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
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Staaf K, Fernström A, Uhlin F. Cannulation technique and complications in arteriovenous fistulas: a Swedish Renal Registry-based cohort study. BMC Nephrol 2021; 22:256. [PMID: 34233650 PMCID: PMC8265150 DOI: 10.1186/s12882-021-02458-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The four cannulation techniques, rope ladder (RL), area puncture (AP), buttonhole with blunt needles (BHb), and buttonhole with sharp needles (BHs), affects the arteriovenous fistula (AVF) in different ways. The aim of this study was to describe the relationship between the different cannulation techniques and the occurrence of AVF complications. METHODS The study was performed as a national registry-based cohort study using data from the Swedish Renal Registry (SRR). Data were collected from January 2014 to October 2019. Seventy of Sweden's dialysis units participate in the registry. We analyzed a total of 1328 AVFs in this study. The risk of complications was compared between the four different cannulation techniques. The risk of AVF complications was measured by the incidence and incidence rate ratio (IRR). We compared the IRRs of complications between different cannulation techniques. RESULTS BHs is the most common cannulation technique in Sweden. It has been used in 55% of the AVFs at some point during their functional patency. BHb (29%), RL (13%), and AP (3%) has been used less. BHb had the lowest risk of complications compared to the other techniques, and a significantly lower risk of stenosis, infiltration, cannulation difficulties, compared to RL and BHs. Cannulation difficulties were significantly more common using AP compared to BHs, and BHb. Infections were not significantly increased using the buttonhole technique. CONCLUSIONS BHb had the lowest risk of complications. Infections were not significantly increased using the buttonhole technique. Dialysis units with a low infection rate may continue to use the buttonhole technique, as the risk of complications is lower.
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Affiliation(s)
- Karin Staaf
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Anders Fernström
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Fredrik Uhlin
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
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Vanegas JM, Salazar-Ospina L, Roncancio GE, Jiménez JN. Staphylococcus aureus colonization increases the risk of bacteremia in hemodialysis patients: a molecular epidemiology approach with time-dependent analysis. Am J Infect Control 2021; 49:215-223. [PMID: 32485274 DOI: 10.1016/j.ajic.2020.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bacteremia is the second cause of death in hemodialysis patients and colonization may be a risk factor. We analyzed the association between Staphylococcus aureus or multidrug-resistant Gram-negative bacteria colonization and bacteremia in hemodialysis patients. METHODS A prospective cohort study was conducted. Colonization status was determined at baseline, 2, and 6 months later. The time-to-first-bacteremia was analyzed using the baseline status and time-dependent nature of colonization. The recurrence of bacteremia given colonization status was evaluated using a Poisson regression model. The genetic relatedness between isolates that colonized and caused bacteremia were established by molecular typing methods. RESULTS Seventy-one patients developed bacteremia over the course of follow-up, with the majority of cases being caused by S aureus (n = 28; 39.4%) and only three caused by multidrug-resistant Gram-negative bacteria. S aureus colonization was associated with an increased risk of bacteremia in time-dependent analysis (HR:4.64; 95%CI: 1.72-12.53) and with recurrence of infection in Poisson model (IRR:5.90, 95%CI: 2.29-15.16). Molecular methods revealed that 77.8% of patients with S aureus bacteremia were colonized with the same strain that caused the infection. CONCLUSIONS S aureus is a cause of endogenous infection in hemodialysis patients. Colonization is associated with both time-to-first-bacteremia and the recurrence of infection. The prompt identification of colonized patients and the evaluation of decolonization protocols are needed.
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Shah S, Chan MR, Lee T. Perspectives in Individualizing Solutions for Dialysis Access. Adv Chronic Kidney Dis 2020; 27:183-190. [PMID: 32891301 DOI: 10.1053/j.ackd.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 11/11/2022]
Abstract
The vascular access is the lifeline for the hemodialysis patient. Previous national vascular access guidelines have emphasized placement of arteriovenous fistulas in most hemodialysis patients. However, the new Kidney Disease Outcomes Quality Initiative guidelines for vascular access, soon to be published, will focus on a patient's end-stage kidney disease "life plan" and take a patient "first" approach. One of the major themes of the new Kidney Disease Outcomes Quality Initiative guidelines is selecting the "right access, for the right patient, at the right time, for the right reason". Given the availability of new advances in biomedical technologies, techniques, and devices in the vascular access field, this shift to a more patient-centered vascular access approach presents unique opportunities to individualize the solutions and care for patients requiring a dialysis vascular access. This review article will address 3 potential areas where there is an unmet need to individualize solutions for dialysis vascular access care: (1) biological approaches to improve vascular access selection and selection of therapies, (2) vascular access care for the post-transplant patient, and (3) vascular access disparities in race, gender, and the elderly patient.
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Kim YS, Kim J, Cheon S, Sohn KM. Higher Risk for All-cause Mortality of Staphylococcus aureus Bacteremia in Patients with Non-Dialysis Dependent Chronic Kidney Disease. Infect Chemother 2020; 52:82-92. [PMID: 32114722 PMCID: PMC7113454 DOI: 10.3947/ic.2020.52.1.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/09/2020] [Indexed: 01/08/2023] Open
Abstract
Background Staphylococcus aureus bacteremia (SAB) is a common and serious infection with a high mortality. Patients with chronic kidney disease (CKD) are vulnerable to SAB, but there have been few studies performed on the clinical characteristics and outcomes of SAB in CKD patients stratified by dialysis. We aimed to estimate the all-cause mortality and identify its predictors in patients with CKD. Materials and Methods We conducted a retrospective study on the patients with SAB hospitalized in a tertiary care center in Korea between March 2014 and December 2018. Kaplan-Meier analysis was performed to compare all-cause mortality following SAB among patients with non-dialysis dependent CKD (ND-CKD), those receiving dialysis, and those without CKD (non-CKD). The predictors of mortality among CKD patients were analyzed by Cox proportional hazards regression. Results As a total, 278 SAB of 43 ND-CKD (31 males), 58 dialysis (39 males), and 177 non-CKD (112 males) patients were included. The 30-day mortality was 39.5% in ND-CKD, 27.6% in dialysis, and 7.9% in non-CKD patients. The hazard ratio of all-cause mortality following SAB in ND-CKD was 2.335 (95% confidence interval, 1.203 – 4.531; P = 0.003), compared to non-CKD patients. For methicillin-resistant S. aureus bacteremia (MRSAB), the hazard ratio of all-cause mortality in ND-CKD was 2.628 (95% CI, 1.074 – 6.435; P = 0.011), compared to dialysis patients. Appropriate antibiotics <48 h was independently related to improved survival following SAB among ND-CKD (adjusted HR, 0.304; 95% CI, 0,108 – 0.857; P = 0.024) and dialysis (adjusted HR, 0.323; 95% CI, 0,116 – 0.897; P = 0.030) patients. Conclusion ND-CKD patients demonstrated poor outcome following SAB and administration of appropriate antibiotics within 48 h could reduce the risk for mortality.
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Affiliation(s)
- Yeon Sook Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
| | - Jungok Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Shinhye Cheon
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyung Mok Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Khalil GM, El-Balat I, Zeid AA, Al-Mohamma AR, Enan G. Prevalence, Characterization and Inhibition by Probiotics of Multidrug Resistant Bacteria Isolated from Renal Failure Patients Undergoing Hemodialysis. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.3923/jms.2020.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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