接受长期血液透析的患者中，由金黄色葡萄球菌菌血症导致的临床结局和费用

Clinical outcomes and costs due to Staphylococcus aureus bacteremia among patients receiving long-term hemodialysis.

作者信息

Engemann John J, Friedman Joelle Y, Reed Shelby D, Griffiths Robert I, Szczech Lynda A, Kaye Keith S, Stryjewski Martin E, Reller L Barth, Schulman Kevin A, Corey G Ralph, Fowler Vance G

机构信息

Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.

出版信息

Infect Control Hosp Epidemiol. 2005 Jun;26(6):534-9. doi: 10.1086/502580.

DOI:10.1086/502580

PMID:16018428

Abstract

OBJECTIVE

To examine the clinical outcomes and costs associated with Staphylococcus aureus bacteremia among hemodialysis-dependent patients.

DESIGN

Prospectively identified cohort study.

SETTING

A tertiary-care university medical center in North Carolina.

PATIENTS

Two hundred ten hemodialysis-dependent adults with end-stage renal disease hospitalized with S. aureus bacteremia.

RESULTS

The majority of the patients (117; 55.7%) underwent dialysis via tunneled catheters, and 29.5% (62) underwent dialysis via synthetic arteriovenous fistulas. Vascular access was the suspected source of bacteremia in 185 patients (88.1%). Complications occurred in 31.0% (65), and the overall 12-week mortality rate was 19.0% (40). The mean cost of treating S. aureus bacteremia, including readmissions and outpatient costs, was $24,034 per episode. The mean initial hospitalization cost was significantly greater for patients with complicated versus uncomplicated S. aureus bacteremia ($32,462 vs $17,011; P = .002).

CONCLUSION

Interventions to decrease the rate of S. aureus bacteremia are needed in this high-risk, hemodialysis-dependent population.

摘要

目的

研究依赖血液透析的患者中金黄色葡萄球菌菌血症的临床结局及相关费用。

设计

前瞻性队列研究。

地点

北卡罗来纳州一家三级大学医学中心。

患者

210例因金黄色葡萄球菌菌血症住院的依赖血液透析的终末期肾病成年患者。

结果

大多数患者（117例；55.7%）通过带隧道的导管进行透析，29.5%（62例）通过人工动静脉内瘘进行透析。185例患者（88.1%）的血管通路被怀疑是菌血症的来源。31.0%（65例）出现并发症，12周总死亡率为19.0%（40例）。治疗金黄色葡萄球菌菌血症的平均费用，包括再次入院和门诊费用，每次发作24,034美元。复杂型与非复杂型金黄色葡萄球菌菌血症患者的平均首次住院费用显著更高（32,462美元对17,011美元；P = 0.002）。