Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients

Kieren Marr, LiKuo Kong, Vance G. Fowler, Ajay Gopal, Daniel J. Sexton, Peter J. Conlon, G. Ralph Corey

Research output: Contribution to journalArticle

Abstract

Background. Staphylococcus aureus bacteremia is frequently associated with metastatic complications and infective endocarditis (IE). The Duke criteria for the diagnosis of IE utilize echocardiographic techniques and are more sensitive than previous criteria. The documentation of IE in patients undergoing hemodialysis (HD) has become increasingly important in order to avoid the overuse of empiric vancomycin and the emergence of antibiotic resistance. Methods. Patients who developed S. aureus bacteremia while undergoing HD at a tertiary medical center or one of four affiliated outpatient HD units were identified. Clinical outcome (death, metastatic complications, IE, and microbiologic recurrence) was assessed during hospitalization and at three months after discharge. Transthoracic and transesophageal echocardiograms were performed and the Duke criteria were used to diagnose IE. Pulse field gel electrophoresis was performed to confirm genetic similarity of recurrent isolates. Results. Four hundred and forty- five patients underwent hemodialysis for 5431.8 patient-months. Sixty-two developed 65 episodes of S. aureus bacteremia (1.2 episodes/100 patient- months). Complications occurred in 27 (44%) patients. Bacteremia recurred in patients who dialyzed through polytetrafluorethylene grafts (44.4% vs. 7.1%, P = 0.0.01), and there was a trend to increased recurrence in patients who received only vancomycin (19.5% vs. 7.1%, P = 0.4). IE was diagnosed in 8 patients (12%), six of whom had normal transthoracic echocardiograms. Conclusions. Sensitive echocardiographic techniques and the Duke criteria for the diagnosis of IE should be used to determine the proper duration of antibiotic therapy in hemodialysis patients with S. aureus bacteremia. This diagnostic approach, coupled with early removal of hardware, may assist in improving outcomes.

Original languageEnglish (US)
Pages (from-to)1684-1689
Number of pages6
JournalKidney International
Volume54
Issue number5
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Bacteremia
Renal Dialysis
Staphylococcus aureus
Endocarditis
Incidence
Vancomycin
Recurrence
Microbial Drug Resistance
Documentation
Electrophoresis
Hospitalization
Outpatients
Gels
Anti-Bacterial Agents
Transplants

Keywords

  • Antibiotic therapy
  • Duke criteria
  • Infective endocarditis
  • Metastatic complications
  • Morbidity in hemodialysis
  • Vancomycin

ASJC Scopus subject areas

  • Nephrology

Cite this

Marr, K., Kong, L., Fowler, V. G., Gopal, A., Sexton, D. J., Conlon, P. J., & Corey, G. R. (1998). Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney International, 54(5), 1684-1689. https://doi.org/10.1046/j.1523-1755.1998.00134.x

Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. / Marr, Kieren; Kong, LiKuo; Fowler, Vance G.; Gopal, Ajay; Sexton, Daniel J.; Conlon, Peter J.; Corey, G. Ralph.

In: Kidney International, Vol. 54, No. 5, 1998, p. 1684-1689.

Research output: Contribution to journalArticle

Marr, K, Kong, L, Fowler, VG, Gopal, A, Sexton, DJ, Conlon, PJ & Corey, GR 1998, 'Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients', Kidney International, vol. 54, no. 5, pp. 1684-1689. https://doi.org/10.1046/j.1523-1755.1998.00134.x
Marr, Kieren ; Kong, LiKuo ; Fowler, Vance G. ; Gopal, Ajay ; Sexton, Daniel J. ; Conlon, Peter J. ; Corey, G. Ralph. / Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. In: Kidney International. 1998 ; Vol. 54, No. 5. pp. 1684-1689.
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abstract = "Background. Staphylococcus aureus bacteremia is frequently associated with metastatic complications and infective endocarditis (IE). The Duke criteria for the diagnosis of IE utilize echocardiographic techniques and are more sensitive than previous criteria. The documentation of IE in patients undergoing hemodialysis (HD) has become increasingly important in order to avoid the overuse of empiric vancomycin and the emergence of antibiotic resistance. Methods. Patients who developed S. aureus bacteremia while undergoing HD at a tertiary medical center or one of four affiliated outpatient HD units were identified. Clinical outcome (death, metastatic complications, IE, and microbiologic recurrence) was assessed during hospitalization and at three months after discharge. Transthoracic and transesophageal echocardiograms were performed and the Duke criteria were used to diagnose IE. Pulse field gel electrophoresis was performed to confirm genetic similarity of recurrent isolates. Results. Four hundred and forty- five patients underwent hemodialysis for 5431.8 patient-months. Sixty-two developed 65 episodes of S. aureus bacteremia (1.2 episodes/100 patient- months). Complications occurred in 27 (44{\%}) patients. Bacteremia recurred in patients who dialyzed through polytetrafluorethylene grafts (44.4{\%} vs. 7.1{\%}, P = 0.0.01), and there was a trend to increased recurrence in patients who received only vancomycin (19.5{\%} vs. 7.1{\%}, P = 0.4). IE was diagnosed in 8 patients (12{\%}), six of whom had normal transthoracic echocardiograms. Conclusions. Sensitive echocardiographic techniques and the Duke criteria for the diagnosis of IE should be used to determine the proper duration of antibiotic therapy in hemodialysis patients with S. aureus bacteremia. This diagnostic approach, coupled with early removal of hardware, may assist in improving outcomes.",
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AU - Gopal, Ajay

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AU - Conlon, Peter J.

AU - Corey, G. Ralph

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N2 - Background. Staphylococcus aureus bacteremia is frequently associated with metastatic complications and infective endocarditis (IE). The Duke criteria for the diagnosis of IE utilize echocardiographic techniques and are more sensitive than previous criteria. The documentation of IE in patients undergoing hemodialysis (HD) has become increasingly important in order to avoid the overuse of empiric vancomycin and the emergence of antibiotic resistance. Methods. Patients who developed S. aureus bacteremia while undergoing HD at a tertiary medical center or one of four affiliated outpatient HD units were identified. Clinical outcome (death, metastatic complications, IE, and microbiologic recurrence) was assessed during hospitalization and at three months after discharge. Transthoracic and transesophageal echocardiograms were performed and the Duke criteria were used to diagnose IE. Pulse field gel electrophoresis was performed to confirm genetic similarity of recurrent isolates. Results. Four hundred and forty- five patients underwent hemodialysis for 5431.8 patient-months. Sixty-two developed 65 episodes of S. aureus bacteremia (1.2 episodes/100 patient- months). Complications occurred in 27 (44%) patients. Bacteremia recurred in patients who dialyzed through polytetrafluorethylene grafts (44.4% vs. 7.1%, P = 0.0.01), and there was a trend to increased recurrence in patients who received only vancomycin (19.5% vs. 7.1%, P = 0.4). IE was diagnosed in 8 patients (12%), six of whom had normal transthoracic echocardiograms. Conclusions. Sensitive echocardiographic techniques and the Duke criteria for the diagnosis of IE should be used to determine the proper duration of antibiotic therapy in hemodialysis patients with S. aureus bacteremia. This diagnostic approach, coupled with early removal of hardware, may assist in improving outcomes.

AB - Background. Staphylococcus aureus bacteremia is frequently associated with metastatic complications and infective endocarditis (IE). The Duke criteria for the diagnosis of IE utilize echocardiographic techniques and are more sensitive than previous criteria. The documentation of IE in patients undergoing hemodialysis (HD) has become increasingly important in order to avoid the overuse of empiric vancomycin and the emergence of antibiotic resistance. Methods. Patients who developed S. aureus bacteremia while undergoing HD at a tertiary medical center or one of four affiliated outpatient HD units were identified. Clinical outcome (death, metastatic complications, IE, and microbiologic recurrence) was assessed during hospitalization and at three months after discharge. Transthoracic and transesophageal echocardiograms were performed and the Duke criteria were used to diagnose IE. Pulse field gel electrophoresis was performed to confirm genetic similarity of recurrent isolates. Results. Four hundred and forty- five patients underwent hemodialysis for 5431.8 patient-months. Sixty-two developed 65 episodes of S. aureus bacteremia (1.2 episodes/100 patient- months). Complications occurred in 27 (44%) patients. Bacteremia recurred in patients who dialyzed through polytetrafluorethylene grafts (44.4% vs. 7.1%, P = 0.0.01), and there was a trend to increased recurrence in patients who received only vancomycin (19.5% vs. 7.1%, P = 0.4). IE was diagnosed in 8 patients (12%), six of whom had normal transthoracic echocardiograms. Conclusions. Sensitive echocardiographic techniques and the Duke criteria for the diagnosis of IE should be used to determine the proper duration of antibiotic therapy in hemodialysis patients with S. aureus bacteremia. This diagnostic approach, coupled with early removal of hardware, may assist in improving outcomes.

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KW - Metastatic complications

KW - Morbidity in hemodialysis

KW - Vancomycin

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