Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality

doi:10.1007/s00134-015-4147-9

. 2016 Feb;42(2):222-32.

doi: 10.1007/s00134-015-4147-9. Epub 2015 Nov 25.

Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality

Affiliations

¹ Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
² Departments of Medicine, Medical Microbiology and Pharmacology, Section of Critical Care Medicine and Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.
³ Section of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.
⁴ Section of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
⁵ Section of Critical Care Medicine, Foothills Hospital and University of Calgary, Calgary, AB, Canada.
⁶ Section of Critical Care Medicine, Royal Jubilee Hospital/Victoria General Hospital and University of British Columbia, Victoria, BC, Canada.
⁷ Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁸ Section of Critical Care Medicine, Geisinger Medical Center, Danville, PA, USA.
⁹ Section of Critical Care Medicine, Rush Medical College, Chicago, IL, USA.
¹⁰ Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. msood99@gmail.com.
¹¹ Ottawa Hospital Research Institute, The Ottawa Hospital, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, P.O. Box 693, Ottawa, ON, K1Y 4E9, Canada. msood99@gmail.com.

PMID: 26607816
DOI: 10.1007/s00134-015-4147-9

Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality

Edward Clark et al. Intensive Care Med. 2016 Feb.

. 2016 Feb;42(2):222-32.

doi: 10.1007/s00134-015-4147-9. Epub 2015 Nov 25.

Affiliations

¹ Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
² Departments of Medicine, Medical Microbiology and Pharmacology, Section of Critical Care Medicine and Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.
³ Section of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.
⁴ Section of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
⁵ Section of Critical Care Medicine, Foothills Hospital and University of Calgary, Calgary, AB, Canada.
⁶ Section of Critical Care Medicine, Royal Jubilee Hospital/Victoria General Hospital and University of British Columbia, Victoria, BC, Canada.
⁷ Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁸ Section of Critical Care Medicine, Geisinger Medical Center, Danville, PA, USA.
⁹ Section of Critical Care Medicine, Rush Medical College, Chicago, IL, USA.
¹⁰ Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. msood99@gmail.com.
¹¹ Ottawa Hospital Research Institute, The Ottawa Hospital, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, P.O. Box 693, Ottawa, ON, K1Y 4E9, Canada. msood99@gmail.com.

PMID: 26607816
DOI: 10.1007/s00134-015-4147-9

Abstract

Objectives: To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney disease patients with septic shock in comparison to septic shock patients not receiving chronic dialysis.

Methods: Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death.

Results: Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients.

Conclusions: The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis.

Keywords: Antimicrobials; Dialysis; Dialysis modality; Epidemiology; In-hospital mortality; Kidney failure; Septic shock.

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Comment in

Crude reality versus data manipulation: is the glass always crystal clear?
Oudemans-van Straaten HM, Parienti JJ. Oudemans-van Straaten HM, et al. Intensive Care Med. 2016 Feb;42(2):290-2. doi: 10.1007/s00134-016-4214-x. Epub 2016 Jan 20. Intensive Care Med. 2016. PMID: 26792421 No abstract available.

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Crude reality versus data manipulation: is the glass always crystal clear?
Oudemans-van Straaten HM, Parienti JJ. Oudemans-van Straaten HM, et al. Intensive Care Med. 2016 Feb;42(2):290-2. doi: 10.1007/s00134-016-4214-x. Epub 2016 Jan 20. Intensive Care Med. 2016. PMID: 26792421 No abstract available.
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References

1. Clin Infect Dis. 2002 Nov 15;35(10):1212-8 - PubMed
1. Infect Dis Clin North Am. 2001 Jun;15(2):385-406, viii - PubMed
1. Chest. 1992 Jun;101(6):1656-62 - PubMed
1. J Am Soc Nephrol. 2009 Nov;20(11):2441-7 - PubMed
1. Crit Care. 2007;11(2):R50 - PubMed

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[1] Clin Infect Dis. 2002 Nov 15;35(10):1212-8 - PubMed

[2] Clin Infect Dis. 2002 Nov 15;35(10):1212-8 - PubMed

[3] Infect Dis Clin North Am. 2001 Jun;15(2):385-406, viii - PubMed

[4] Infect Dis Clin North Am. 2001 Jun;15(2):385-406, viii - PubMed

[5] Chest. 1992 Jun;101(6):1656-62 - PubMed

[6] Chest. 1992 Jun;101(6):1656-62 - PubMed

[7] J Am Soc Nephrol. 2009 Nov;20(11):2441-7 - PubMed

[8] J Am Soc Nephrol. 2009 Nov;20(11):2441-7 - PubMed

[9] Crit Care. 2007;11(2):R50 - PubMed

[10] Crit Care. 2007;11(2):R50 - PubMed

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Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality

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Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality

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