BURDEN OF HAEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS IN AUSTRALIA: A NATIONAL DATA-LINKAGE STUDY
Ben Lazarus1,2,3, Kevan R Polkinghorne2,3, Martin Gallagher1,4, Nicholas Gray5,6, Sarah Coggan1, Girish Talaulikar7,8, Sradha Kotwal1,9
1The George Institute for Global Health, Sydney, NSW, Australia
2Monash University, Clayton, VIC, Australia
3Monash Health, Clayton, VIC, Australia
4University of New South Wales, Sydney, NSW, Australia
5Sunshine Coast University Hospital, Birtinya, QLD, Australia
6University of the Sunshine Coast, Sippy Downs, QLD, Australia
7The Canberra Hospital, Garran, ACT, Australia
8Australian National University, Acton, ACT, Australia
9Prince of Wales Hospital, Sydney, NSW, Australia
Abstract
Aim: To quantify the health burden of haemodialysis catheter-related bloodstream infection (HDCRBSI) among chronic haemodialysis patients in Australia.
Background: Haemodialysis catheters are widely used and prone to infection. The health impact of catheter infections in Australia is unknown.
Methods: Patients who commenced chronic haemodialysis via a catheter in the REDUCCTION trial (Dec 2016- Mar 2020) were followed from first catheter insertion to last catheter removal, or end of the trial if a catheter remained. Hospitalizations in all States and Territories (except WA) were probabilistically linked and classified using the principal ICD10-AM diagnostic code. Hospitalizations for vascular access infection (VAI) or bacteraemia, with concurrent HDCRBSI reported at time of admission, were characterized.
Results: 3436 patients commenced chronic haemodialysis via a catheter and were followed for 873,433 days. Baseline characteristics were comparable with the Australian haemodialysis population. 1502 (17.6%; 15,217 bed days) of 8545 multiple-day admissions (65,851 bed days) were due to infection. Hospitalizations for VAI (n=316; 2990 bed days) and bacteraemia (n=309; 4844 bed days) were longer than for pneumonia or cellulitis (all p<0.01), accounted for 42% of infectious admissions, and 51.5% of infectious bed days. Concurrent HDCRBSI at time of hospitalization was reported in 124 admissions, 98 (79%) with primary code for VAI or bacteraemia. The median length of stay was 9 days (IQR 5-14), 16 (16.3%) required intensive care (median 57.5 hours, IQR 30 – 98.5), 9 (9.2%) had metastatic endocarditis, osteomyelitis, or septic arthritis, and 3 patients died in hospital. 27 HDCRBSI occurred more than 2 days into admission.
Conclusion: Catheter-related infections are a major source of infectious hospitalization among Australians receiving chronic haemodialysis via a catheter. The burden of HDCRBSI is substantial.
Biography
Ben is a nephrologist at Monash Health, editorial fellow at the Journal of the American Society of Nephrology, and third year PhD candidate at Monash University and The George Institute of Global Health.