Ms. Samantha Crimmins1,2, Dr Wiraaj Agnihotri3,4, Professor Germaine Wong5,6, Dr Patricia E. Ferguson7,8,9
1Sydney Medical Program, The University of Sydney, Australia, 2Westmead Clinical School, The University of Sydney, Australia, 3Canberra Health Services, Australia, 4Australian National University, Australia, 5Sydney School of Public Health, The University of Sydney, Australia, 6Centre for Kidney Research, The Children's Hospital at Westmead, Australia, 7Sydney Institute for Infectious Diseases, The University of Sydney, Australia, 8New South Wales Biocontainment Centre, Australia, 9Department of Infectious Diseases, Westmead Hospital, Australia
Biography:
Samantha Crimmins is a final year medical student at the University of Sydney. She is currently completing her clinical placements at Westmead Hospital and developed an interest in medical research while performing a university research project.
Abstract:
Introduction
Bloodstream infections (BSI) represent a significant cause of morbidity and mortality in patients with kidney failure receiving haemodialysis. We describe the burden of BSI in haemodialysis patients in Western Sydney, stratified by vascular access type and dialysis location.
Methods
All adults on maintenance haemodialysis with a positive blood culture reported by Western Sydney Local Health District (WSLHD) laboratories from January 2021 to December 2022 were included. Patient characteristics, vascular access, dialysis facility, microbiological data and clinical outcomes were obtained from digital medical records. Total dialysis days were captured for all WSLHD dialysis patients. Access-related BSI were defined as central-line associated BSI or localised infection at the access site. Ethics approval was given by WSLHD HREC.
Results
Of 92 BSI episodes identified, 62 (67%) were access-related BSI. Rates of BSI per 1,000 dialysis days were highest with a tunnelled central venous catheter (0.57) followed by non-tunnelled central venous catheter (0.35), arteriovenous graft (0.31) and arteriovenous fistula (0.21). BSI rates were highest at hospitals (0.45) followed by satellite centres (0.28) and home (0.03). The predominant pathogens were Staphylococcus aureus (33%), coagulase-negative staphylococci (25%) and Escherichia coli (13%). Patient-important outcomes of 30-day mortality and changes to kidney replacement therapy occurred in 12% and 35% of cases respectively.
Conclusion
BSI in haemodialysis patients have a substantial adverse impact, with 67% related to the access device. Home haemodialysis and dialysis via arteriovenous fistula should be encouraged as the lowest risk options. Infection surveillance remains a key tool in monitoring and then preventing haemodialysis-associated BSI.