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Abstract: SA-PO452

Characteristics and Outcomes Among Hospitalized Patients With Gram-Negative Bacteremia (GNB) Who Require Kidney Replacement Therapy (KRT)

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 Medical Center, Durham, North Carolina, United States
  • Park, Lawrence, Duke University School of Medicine, Durham, North Carolina, United States
  • Dagher, Michael M., Duke University Health System, Durham, North Carolina, United States
  • Eichenberger, Emily, Duke University School of Medicine, Durham, North Carolina, United States
  • Wyatt, Christina M., Duke University School of Medicine, Durham, North Carolina, United States
  • Fowler, Vance, Duke University School of Medicine, Durham, North Carolina, United States
Background

GNB is a common cause of sepsis in patients requiring KRT, and is associated with morbidity and mortality. These adverse outcomes are partially the result of increasing antibiotic-resistant bacterial strains, but other contributing patient and bacterial factors are unclear. Further, it is unknown if patients hospitalized with GNB who develop acute kidney injury (AKI) requiring KRT prior to bacteremia have disparate outcomes compared to patients on maintenance hemodialysis (HD) hospitalized with GNB. We evaluated differences in characteristics and outcomes in hospitalized patients with GNB with AKI requiring KRT vs those on maintenance HD and assessed associations between clinical and bacterial characteristics and outcomes.

Methods

Hospitalized, non-neutropenic adults with GNB who required KRT were prospectively enrolled from Jan 1, 2002 to December 31, 2016 (n=185). Clinical and bacterial characteristics and outcomes between groups were evaluated with Mann-Whitney-U or Fisher’s Exact test. Associations with outcomes were estimated using logistic regression.

Results

Among hospitalized patients with GNB, those patients with AKI requiring KRT (n=38) compared to patients on maintenance HD (n=147) were more acutely ill (Acute Physiology Score, median (APS) 13.0 vs APS 9.0; p=0.03), more likely to be a transplant recipient (44.7% vs 18.4%; p=0.001), less likely to identify as Black race (18.4% vs 67.3%; p<0.001), and more likely to have a multi-drug resistant (MDR) bacterial strain (47.4% vs 27.1%; p=0.02). Additionally, patients with AKI requiring KRT were more likely to have clinical complications (65.8% vs 40.1%; p=0.006) and to die (57.9% vs 24.5%; p<0.001) compared to patients on maintenance HD. Among all patients, MDR bacterial strains and non-vascular source of infection were associated with all-cause mortality (Odds Ratio (OR) 4.36, 95% Confidence Interval (CI) 1.83-11.00 and OR 6.94, 95% CI 2.11-28.48, respectively).

Conclusion

Hospitalized patients with GNB and HD-dependence are at significant risk for adverse outcomes. Both clinical and bacterial characteristics contribute to these outcomes, with clinical complications and mortality rates highest among patients who develop AKI requiring KRT.

Funding

  • Other NIH Support