Nephrology Dialysis Transplantation, Vol 13, Issue 1 139-145, Copyright © 1998 by Oxford University Press
J Nielsen, H Kolmos and F Espersen
Background: Central venous catheter-related infections
are the most common cause of nosocomial S. aureus
bacteraemia in Denmark. Central venous catheters are often used for
dialysis, and patients on dialysis often run into staphylococcal
infections. The purpose of this study was to investigate S.
aureus bacteraemia among dialysis patients, especially those
related to dialysis catheters. Methods: This was a
retrospective study of 14 387 consecutive S. aureus
bacteraemia cases during the period 1976-93, of which 793 cases occurred
among dialysis patients. By reviewing the case records, 65 dialysis
catheter-related cases were described more thoroughly.
Results: The number of S. aureus
bacteraemia cases among dialysis patients as a proportion of all cases in
Denmark has increased from 5.2 to 14.7% during the study period, but the
annual incidence among these patients has been almost stable during the
period (median 5.7% (3.2-9.0%)). Patients on dialysis had a lower mortality
than other patients with S. aureus bacteraemia (18.8
vs 29.0%), but a four times higher mortality from
central venous catheter-related S. aureus bacteraemia
(5.3 vs 1.3%, P <0.001). The mortality from
dialysis catheter-related S. aureus bacteraemia was
correlated with greater age (median 71 years (57-73)
vs median 56.5 years (15-76), P <0.01) and with
septic shock (55.5 vs 7.1%, P <0.05). Patients
on dialysis had a lower frequency of S. aureus
endocarditis (3.3 vs 5.4%, P <0.01) and of
S. aureus bone and joint infections (3.3
vs 8.2%, P <0.001) than other patients.
Patients undergoing dialysis had a later onset of catheter-related
S. aureus bacteraemia than other patients (median 15
days (1-145) vs 5 days (1-134), P <0.05).
Conclusions: Patients on dialysis are at a high risk
of S. aureus bacteraemia and they have a four times
higher mortality from central venous catheter-related S.
aureus bacteraemia than other patients. There is need for
prospective studies in which patients as well as catheters are followed
more thoroughly to study the pathogenesis of dialysis catheter-related
infections. Key words: dialysis; S.
aureus; bacteraemia; septicaemia; central venous catheters
ORIGINAL ARTICLES
Staphylococcus aureus bacteraemia among patients undergoing dialysis-focus on dialysis catheter-related cases
Departments of Nephrology and Clinical Microbiology, Hvidovre Hospital, Denmark; Department of Research and Development, Division of Microbiology, Statens Serum Institut, Copenhagen, Denmark; Corresponding author at: Department of Research and Development, Statens Serum Institut, Artillerivej 5, DK-230 Copenhagen S, Denmark
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