Inrig Jula K, Reed Shelby D, Szczech Lynda A, Engemann John J, Friedman Joelle Y, Corey G Ralph, Schulman Kevin A, Reller L Barth, Fowler Vance G
Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, NC 27705, USA.
Clin J Am Soc Nephrol. 2006 May;1(3):518-24. doi: 10.2215/CJN.01301005. Epub 2006 Mar 22.
The association between hemodialysis vascular access type, costs, and outcome of Staphylococcus aureus bacteremia (SAB) among patients with ESRD remains incompletely characterized. This study was undertaken to compare resource utilization, costs, and clinical outcomes among SAB-infected patients with ESRD by hemodialysis access type. Adjusted comparisons of costs and outcomes were based on multivariable linear regression and multivariable logistic regression models, respectively. A total of 143 hospitalized hemodialysis-dependent patients had SAB at Duke University Medical Center between July 1996 and August 2001. A total of 111 (77.6%) patients were hospitalized as a result of suspected bacteremia; 32 (22.4%) were hospitalized for other reasons. Of the 111 patients, 59.5% (n = 66) had catheters as their primary access type, 36% (n = 40) had arteriovenous (AV) grafts, and 4.5% (n = 5) had AV fistulas. Patients with fistulas were excluded from analyses because of small numbers. Patients with catheters were more likely to be white, had shorter dialysis vintage, and had higher Acute Physiology and Chronic Health Evaluation II scores compared with patients with grafts. Unadjusted 12-wk mortality did not significantly differ between patients with catheters compared with patients with grafts (22.7 versus 10.0%; P = 0.098); neither did 12-wk costs differ by access type ($22,944 +/- 18,278 versus $23,969 +/- 13,731, catheter versus graft; P > 0.05). In adjusted analyses, there was no difference in 12-wk mortality (odds ratio 1.63; 95% confidence interval 0.29 to 9.02; catheter versus graft) or 12-wk costs (means ratio 0.84; 95% confidence interval 0.60 to 1.17; catheter versus graft) among SAB-infected patients with ESRD on the basis of hemodialysis access type. Twelve-week mortality and costs that are associated with an episode of SAB are high in hemodialysis patients, regardless of vascular access type. Efforts should focus on the prevention of SAB in this high-risk group.
终末期肾病（ESRD）患者中，血液透析血管通路类型、成本与金黄色葡萄球菌菌血症（SAB）结局之间的关联仍未完全明确。本研究旨在比较不同血液透析血管通路类型的ESRD患者发生SAB时的资源利用、成本及临床结局。成本和结局的校正比较分别基于多变量线性回归模型和多变量逻辑回归模型。1996年7月至2001年8月期间，杜克大学医学中心共有143例依赖血液透析的住院患者发生SAB。其中，111例（77.6%）患者因疑似菌血症住院，32例（22.4%）因其他原因住院。在111例患者中，59.5%（n = 66）的主要血管通路类型为导管，36%（n = 40）为动静脉（AV）移植物，4.5%（n = 5）为AV内瘘。因数量较少，内瘘患者被排除在分析之外。与移植物患者相比，导管患者更可能为白人，透析时间较短，急性生理与慢性健康状况评分II较高。导管患者与移植物患者的未校正12周死亡率无显著差异（22.7%对10.0%；P = 0.098）；12周成本也不因血管通路类型而异（导管组为22,944美元±18,278美元，移植物组为23,969美元±13,731美元；P > 0.05）。在校正分析中，基于血液透析血管通路类型，ESRD合并SAB感染患者的12周死亡率（比值比1.63；95%置信区间0.29至9.02；导管组对移植物组）或12周成本（均值比0.84；95%置信区间0.60至1.17；导管组对移植物组）无差异。无论血管通路类型如何，血液透析患者发生SAB时的12周死亡率和成本都很高。应致力于在这一高危人群中预防SAB。
