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. 2020 Mar;52(1):82-92.
doi: 10.3947/ic.2020.52.1.82. Epub 2020 Feb 20.

Higher Risk for All-cause Mortality of Staphylococcus aureus Bacteremia in Patients with Non-Dialysis Dependent Chronic Kidney Disease

Yeon Sook Kim  1 , Jungok Kim  2 , Shinhye Cheon  2 , Kyung Mok Sohn  2
Affiliations

Higher Risk for All-cause Mortality of Staphylococcus aureus Bacteremia in Patients with Non-Dialysis Dependent Chronic Kidney Disease

Yeon Sook Kim et al. Infect Chemother. 2020 Mar.

Abstract

Background: Staphylococcus aureus bacteremia (SAB) is a common and serious infection with a high mortality. Patients with chronic kidney disease (CKD) are vulnerable to SAB, but there have been few studies performed on the clinical characteristics and outcomes of SAB in CKD patients stratified by dialysis. We aimed to estimate the all-cause mortality and identify its predictors in patients with CKD.

Materials and methods: We conducted a retrospective study on the patients with SAB hospitalized in a tertiary care center in Korea between March 2014 and December 2018. Kaplan-Meier analysis was performed to compare all-cause mortality following SAB among patients with non-dialysis dependent CKD (ND-CKD), those receiving dialysis, and those without CKD (non-CKD). The predictors of mortality among CKD patients were analyzed by Cox proportional hazards regression.

Results: As a total, 278 SAB of 43 ND-CKD (31 males), 58 dialysis (39 males), and 177 non-CKD (112 males) patients were included. The 30-day mortality was 39.5% in ND-CKD, 27.6% in dialysis, and 7.9% in non-CKD patients. The hazard ratio of all-cause mortality following SAB in ND-CKD was 2.335 (95% confidence interval, 1.203 - 4.531; P = 0.003), compared to non-CKD patients. For methicillin-resistant S. aureus bacteremia (MRSAB), the hazard ratio of all-cause mortality in ND-CKD was 2.628 (95% CI, 1.074 - 6.435; P = 0.011), compared to dialysis patients. Appropriate antibiotics <48 h was independently related to improved survival following SAB among ND-CKD (adjusted HR, 0.304; 95% CI, 0,108 - 0.857; P = 0.024) and dialysis (adjusted HR, 0.323; 95% CI, 0,116 - 0.897; P = 0.030) patients.

Conclusion: ND-CKD patients demonstrated poor outcome following SAB and administration of appropriate antibiotics within 48 h could reduce the risk for mortality.

Keywords: Chronic kidney disease; Dialysis; Mortality; Staphylococcus aureus bacteremia.

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Conflict of interest statement

No conflicts of interest.

Figures

Figure 1
Figure 1
Enrollment of patients with Staphylococcus aureus bacteremia (SAB). ND-CKD, non-dialysis dependent chronic kidney disease; CKD, chronic kidney disease.
Figure 2
Figure 2
Kaplan-Meier estimate of probability of survival from Staphylococcus aureus bacteremia (A) Overall, (B) Patients with methicillin-resistant Staphylococcus aureus bacteremia, (C) Patients with methicillin-susceptible Staphylococcus aureus bacteremia. CKD, chronic kidney disease.
See this image and copyright information in PMC

References

    1. Keynan Y, Rubinstein E. Staphylococcus aureus bacteremia, risk factors, complications, and management. Crit Care Clin. 2013;29:547–562. - PubMed
    1. Jensen AG, Wachmann CH, Espersen F, Scheibel J, Skinhøj P, Frimodt-Møller N. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med. 2002;162:25–32. - PubMed
    1. Benfield T, Espersen F, Frimodt-Møller N, Jensen AG, Larsen AR, Pallesen LV, Skov R, Westh H, Skinhøj P. Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000. Clin Microbiol Infect. 2007;13:257–263. - PubMed
    1. Sarnak MJ, Jaber BL. Pulmonary infectious mortality among patients with end-stage renal disease. Chest. 2001;120:1883–1887. - PubMed
    1. Prezant DJ. Effect of uremia and its treatment on pulmonary function. Lung. 1990;168:1–14. - PubMed