Chaudry Mavish S, Gislason Gunnar H, Kamper Anne-Lise, Rix Marianne, Larsen Anders R, Petersen Andreas, Andersen Paal S, Skov Robert L, Fosbøl Emil L, Westh Henrik, Schønheyder Henrik C, Benfield Thomas L, Fowler Vance G, Torp-Pedersen Christian, Bruun Niels E
Department of Cardiology, Herlev-Gentofte Hospital University of Copenhagen, Copenhagen, Denmark.
The National Institute of Public Health, University of Southern Denmark and The Danish Heart Foundation, Odense, Denmark.
Hemodial Int. 2019 Apr;23(2):230-238. doi: 10.1111/hdi.12728. Epub 2019 Feb 19.
Staphylococcus aureus bacteremia (SAB) is a high-risk infection and feared complication related to hemodialysis. This study aimed to investigate incidence and risk factors for SAB depending on hemodialysis access type.
The Danish National Registry on Regular Dialysis and Transplantation was used to identify patients from January 1, 1996 to December 31, 2011 with end-stage kidney disease. Patients were followed until death, the first episode of SAB, or end of study (December 31, 2011). Independent risk factors were assessed by multivariable Poisson regression with time-updated exposure variables.
Total of 9997 patients were included. The initial modality of renal replacement therapy was hemodialysis in 6826 patients and peritoneal dialysis in 2882 patients; 289 patients had preemptive kidney transplantation. SAB occurred in 1278 patients (12.8%). The incidence rate of SAB declined after 90 days and leveled off after 270 days in hemodialysis, peritoneal dialysis, and kidney transplanted. As compared to peritoneal dialysis, the adjusted rate ratio (RR) for SAB was 7.42 (95% CI 5.63-9.79) in uncuffed central venous catheter (CVC), 5.68 (95% CI 4.39-7.36) in cuffed CVC, 4.43 (95% CI 2.10-9.53) in arteriovenous graft, and 3.40 (95% CI 2.79-4.15) in arteriovenous fistula. SAB risk did not differ between uncuffed and cuffed CVC. The risk of SAB was increased during the first three months of renal replacement therapy especially for CVC (RR 11.37 [95% CI7.09-18.22]) compared with peritoneal dialysis. Diabetes mellitus (RR 1.35 [95% CI 1.20-1.51]) and male sex (RR 1.15 [95% CI 1.03-1.29]) were also associated with SAB.
Patients on hemodialysis had a high incidence rate of SAB, particularly those undergoing hemodialysis via CVC. SAB risk was comparable for cuffed and uncuffed CVC. Diabetes mellitus, male sex, and the first three months in renal replacement therapy were independently associated with SAB.
金黄色葡萄球菌菌血症（SAB）是一种高危感染，也是与血液透析相关的可怕并发症。本研究旨在调查根据血液透析通路类型划分的SAB发病率及危险因素。
使用丹麦全国定期透析和移植登记处的数据，确定1996年1月1日至2011年12月31日期间患有终末期肾病的患者。对患者进行随访，直至死亡、首次发生SAB或研究结束（2011年12月31日）。通过多变量泊松回归和时间更新暴露变量评估独立危险因素。
共纳入9997例患者。肾脏替代治疗的初始方式为血液透析的有6826例患者，腹膜透析的有2882例患者；289例患者接受了抢先肾移植。1278例患者（12.8%）发生了SAB。在血液透析、腹膜透析和肾移植患者中，SAB的发病率在90天后下降，270天后趋于平稳。与腹膜透析相比，无套囊中心静脉导管（CVC）发生SAB的校正率比（RR）为7.42（95%CI 5.63-9.79），有套囊CVC为5.68（95%CI 4.39-7.36），动静脉移植物为4.43（95%CI 2.10-9.53），动静脉内瘘为3.40（95%CI 2.79-4.15）。无套囊和有套囊CVC的SAB风险无差异。与腹膜透析相比，在肾脏替代治疗的前三个月，尤其是CVC患者中，SAB风险增加（RR 11.37 [95%CI 7.09-18.22]）。糖尿病（RR 1.35 [95%CI 1.20-1.51]）和男性（RR 1.15 [95%CI 1.03-1.29]）也与SAB相关。
血液透析患者的SAB发病率较高，尤其是那些通过CVC进行血液透析的患者。有套囊和无套囊CVC的SAB风险相当。糖尿病、男性以及肾脏替代治疗的前三个月与SAB独立相关。
