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Abstract: PO0886

Differences in Clinical Characteristics and Outcomes Between Hemodialysis-Dependent and Non-Hemodialysis-Dependent Patients with Gram-Negative Bacteremia

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sinclair, Matthew R., Duke University School of Medicine, Durham, North Carolina, United States
  • Thaden, Joshua T., Duke University School of Medicine, Durham, North Carolina, United States
  • Ruffin, Felicia, Duke University Hospital, Durham, North Carolina, United States
  • Park, Lawrence, Duke University School of Medicine, Durham, North Carolina, United States
  • Dagher, Michael M., Duke University Hospital, Durham, North Carolina, United States
  • Wyatt, Christina M., Duke University School of Medicine, Durham, North Carolina, United States
  • Fowler, Vance G., Duke University School of Medicine, Durham, North Carolina, United States
Background

Gram-negative bacteremia (GNB) is a common and potentially lethal infection among hemodialysis (HD)-dependent patients. The determinants of clinical outcomes in HD-dependent patients with GNB are incompletely understood. We compared clinical characteristics and outcomes between HD- and non-HD-dependent patients with GNB in a large cohort of hospitalized patients and subsequently examined associations between specific characteristics and all-cause mortality among HD-dependent patients.

Methods

Hospitalized, non-neutropenic adults with GNB were prospectively enrolled from Jan 1, 2002 to July 1, 2015. Clinical characteristics and outcome data were collected. Differences between HD- and non-HD-dependent patients were estimated using means/standard deviations or counts/percentages with statistical significance evaluated with independent sample T-tests or Pearson’s chi-squared test. Associations between clinical characteristics and outcomes were estimated using logistic regression.

Results

Among 1,827 unique participants, 180 were HD-dependent (9.9%). Compared to non-HD-dependent patients, HD-dependent patients were younger (58.6 vs 61.0 years, p=0.05) and more likely to be Black (55.6% vs 26.4%, p<0.001), to have diabetes (56.1% vs 32.1%, p<0.001), and to die prior to hospital discharge (28.9% vs 19.9%, p=0.01). Among HD-dependent patients, having a higher total APACHE II score (Odds Ratio [OR] 1.15, Confidence Interval [CI] 1.08-1.23), non-central venous access source of infection (OR 8.00, CI 2.71-23.60) or hospital-acquired infection (OR 4.46, CI 2.19-9.09) were associated with in-house mortality, while Black race (OR 0.31, CI 0.16-0.63) was inversely associated with mortality.

Conclusion

Clinical characteristics and outcomes differed significantly between HD- and non-HD dependent patients with GNB. Mortality among HD-dependent patients may be partially explained by source of infection, site of acquisition, and severity of illness at time of infection. The association between race and patient outcome requires further study.

Funding

  • NIDDK Support