Abstract
Vascular access infection is one of the major contributors to hemodialysis (HD) patient morbidity and mortality. There is a paucity of consensus guidelines on vancomycin use in the HD population. The primary objective of this study was to determine if vancomycin serum concentrations were associated with positive outcomes in HD patients with Gram-positive bacteremia. A retrospective cohort study conducted at a 443-bed tertiary teaching county hospital from January 1, 2010 to January 1, 2016 was performed. Patients aged 18-89, with chronic renal failure on hemodialysis who presented with positive blood cultures with Gram-positive bacteria and received intravenous vancomycin for at least 24 hours were evaluated. A multivariate analysis was utilized comparing factors related to outcomes including Simplified Acute Physiology Score II (SAPS II), loading dose, 30-day mortality and vancomycin serum concentrations. A total of 139 patients were obtained, 90 of whom had documented pre-dialysis serum vancomycin concentrations. A multivariate analysis showed that a lower SAPS II score [OR 1.220 (95% CI: 1.086-1.370, p < 0.0001)], a higher loading dose/kg [OR 0.7911 (0.6302-0.9929, p = 0.0239)], and pre-dialysis concentrations between 15 and 20 mcg/mL [0.05437 (95% CI: 0.0033-0.8891, p = 0.0099)] were associated with decreased mortality (overall multivariate model, p < 0.0001). When patient acuity and loading dosing are taken into account, pre-dialysis vancomycin serum concentrations between 15 and 20 mcg/mL were associated with decreased mortality in Gram-positive bacteremic intermittent HD patients. Further prospective studies are needed to assess whether targeting a pre-dialysis serum vancomycin concentration of 15-20 mcg/mL can improve mortality.
Highlights
According to the United States Renal Data System (USRDS) 2016 annual report, 87.9% of incident end-stage renal disease (ESRD) patients initiated renal replacement therapy with hemodialysis (HD)
When patient acuity and loading dosing are taken into account, pre-dialysis vancomycin serum concentrations between 15 and 20 mcg/mL were associated with decreased mortality in Gram-positive bacteremic intermittent HD patients
The goal of this study is to determine if a pre-dialysis vancomycin serum concentration of 15–20 mcg/mL is associated with positive outcomes in patients undergoing intermittent hemodialysis (IHD) with Gram-positive bacteremia
Summary
According to the United States Renal Data System (USRDS) 2016 annual report, 87.9% of incident end-stage renal disease (ESRD) patients initiated renal replacement therapy with hemodialysis (HD). While the rate of hospitalization in HD patients due to infection has decreased to 10.6% over the years, it remains a significant issue in this patient [1]. Often related to vascular access, is one of the major contributors to HD patient morbidity and mortality, accounting for 9.5 to 36% of deaths [2,3]. Vascular access infections (most commonly found in patients utilizing dialysis catheters) are reported to be the source in up to 48 to 73% of all bacteremias in HD patients [4]. How to cite this article Rambaran K, Alzghari S K, Seifert C F (July 03, 2018) Evaluation of Factors which Influence Mortality in Gram-positive Bacteremia in Hemodialysis Patients.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.