The epidemiology of haemodialysis catheter infections in Australia, 2016-20: a prospective cohort study

Abstract

Objectives: To investigate the epidemiology in Australia of catheter-related infections in a national cohort of adults with kidney failure with incident haemodialysis central venous catheters (CVCs).

Study design: Cohort study nested within a cluster-randomised trial (REDUcing the burden of dialysis Catheter Complications, REDUCCTION); analysis of prospectively collected trial data, linked with Australian and New Zealand Dialysis and Transplant (ANZDATA) registry and state hospitalisations data.

Setting: Thirty-four health services in Australia (excluding Western Australia) that provide chronic haemodialysis and participated in the REDUCCTION trial.

Participants: Adults (18 years or older) with chronic kidney failure who received incident haemodialysis CVCs during 20 December 2016 - 31 March 2020.

Main outcome measures: Hospitalisation with any haemodialysis CVC infection; haemodialysis CVC-related bloodstream infections reported during the trial and verified by an independent panel.

Results: Our analysis included 3943 adults with chronic kidney failure; their mean age was 60.4 years (standard deviation, 15.5 years); 1556 were women (39.5%) and 485 were Aboriginal or Torres Strait Islander people (12.3%). Catheter-related infections were coded for 644 hospitalisations (24.5 per 100 patient-years; 95% confidence interval [CI], 22.6-26.4 per 100 patient-years); the incidence was higher among people under 55 years of age (adjusted incidence rate ratio [IRR], 1.55; 95% CI, 1.21-1.98) and those aged 55-70 years (adjusted IRR, 1.34; 95% CI, 1.05-1.70) than among people over 70 years of age. Community-onset haemodialysis catheter-related bloodstream infections were responsible for 159 hospitalisations (8.2% of 1938 infection-related hospitalisations); 57 of 650 infection-related hospitalisations of people under 55 years of age (8.8%), 62 of 640 of people aged 55-70 years (9.7%), and 40 of 648 of people over 70 years of age (6.2%). The median length of hospital stay with community-onset haemodialysis CVC-related bloodstream infections was ten days (interquartile range, 5-15 days), metastatic spread of infection was detected in twelve cases (7.5%), and four people died in hospital (2.5%); 40 removed haemodialysis CVCs did not require replacement. Nineteen of 121 hospitalisations for which the information was available included intensive care unit admissions (15.7%; median stay, 2.7 days; IQR, 1.1-4.6 days). The risk of haemodialysis CVC-related Staphylococcus aureus bloodstream infection declined with age (relative risk ratio, 0.65 per decade; 95% CI, 0.47-0.89).

Conclusions: The health burden of haemodialysis CVC infections in Australia is substantial, particularly among adults under 70 years of age.

Keywords: Infection control; Kidney diseases; Renal dialysis; Vascular diseases.