Infect Chemother.  2020 Mar;52(1):82-92. 10.3947/ic.2020.52.1.82.

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

• Kim YS
• Kim J
• Cheon S
• Sohn KM

• KMID: 2507329
• DOI: http://doi.org/10.3947/ic.2020.52.1.82

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 nonCKD (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.

Keyword

Staphylococcus aureus bacteremia; Chronic kidney disease; Dialysis; Mortality

Figure

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  Figure 1 Enrollment of patients with Staphylococcus aureus bacteremia (SAB).ND-CKD, non-dialysis dependent chronic kidney disease; CKD, chronic kidney disease.

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  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.

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