Risk Factors for Infections in Patients Treated with Dialysis
Wright, Seth.
2017
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Abstract: Infections in
patients treated with dialysis are associated with substantial morbidity and mortality,
but their incidence rates, patterns and potential risk factors are poorly described.
Infections (defined as: a positive blood or peritoneal culture; ≥5 days of
in-center antibiotics or an out-of-center oral, IV, or intraperitoneal (IP) antibiotic
order; or hospitalization or death ... read morewith an infection-related code) were evaluated in all
patients treated by a large U.S. dialysis provider (DCI) from October 2009-September
2014. Dialysis modality/vascular access were defined by those in use at the time of an
event. In patients incident to dialysis, multivariate Cox regression was used to
evaluate risk factors for infection including access type, immunosuppressants and
indices of iron status. A total of 32,977 patients contributed 66,099 patient-years of
data. In the study period, 24% of patients died with 9% of the deaths attributed to
infection. The most common infections causing hospitalization were pneumonia (29%),
cellulitis/soft tissue (17%), and bacteremia/sepsis (13%). On average, 27 days per
patient-year were spent under antibiotic coverage, and the rate of positive blood or
peritoneal cultures was 13.3/100 patient-years. Generally, unadjusted rates were highest
for patients using catheters, peritoneal dialysis next, and lowest for patients using
fistulas. In multivariable analysis, risk factors for an infection (as a composite of
the above outcomes) included: dialysis via catheter [HR 1.71 (1.63-1.78 95% CI) or
peritoneal dialysis [HR 1.39 (1.31-1.47))] vs fistula; white race [HR 1.27 (1.20-1.33)]
vs black; Medicare/Medicaid vs commercial insurance [HR 1.09 (1.03-1.15)]; and the use
of immunosuppressive medications [HR 1.16 (1.10-1.23)]. Iron indices such as ferritin
and iron saturation showed significant but divergent relationship with infection risk,
potentially reflecting the complexity and lack of specificity of these measures. These
detailed, modality-specific data provide background information on the rate and type of
fatal and non-fatal infections in dialysis patients. Pneumonias and cellulitis made up
nearly half of the infectious admissions, and antibiotic exposure was extremely high.
Catheter and peritoneal dialysis use were associated with particularly high risk even
after adjusting for comorbidity and background differences. The use of immunosuppressive
medications represents a potentially modifiable risk
factor
Thesis (M.S.)--Tufts University, 2017.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Dan Weiner.
Committee: Mark Sarnak, and Hocine Tighiouart.
Keyword: Medicine.read less - ID:
- 47429n25n
- Component ID:
- tufts:22769
- To Cite:
- TARC Citation Guide EndNote
