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Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients.

Publication ,  Journal Article
Marr, KA; Kong, L; Fowler, VG; Gopal, A; Sexton, DJ; Conlon, PJ; Corey, GR
Published in: Kidney Int
November 1998

BACKGROUND: Staphylococcus aureus bacteremia is frequently associated with metastatic complications and infective endocarditis (IE). The Duke criteria for the diagnosis of IE utilize echocardiographic techniques and are more sensitive than previous criteria. The documentation of IE in patients undergoing hemodialysis (HD) has become increasingly important in order to avoid the overuse of empiric vancomycin and the emergence of antibiotic resistance. METHODS: Patients who developed S. aureus bacteremia while undergoing HD at a tertiary medical center or one of four affiliated outpatient HD units were identified. Clinical outcome (death, metastatic complications, IE, and microbiologic recurrence) was assessed during hospitalization and at three months after discharge. Transthoracic and transesophageal echocardiograms were performed and the Duke criteria were used to diagnose IE. Pulse field gel electrophoresis was performed to confirm genetic similarity of recurrent isolates. RESULTS: Four hundred and forty-five patients underwent hemodialysis for 5431.8 patient-months. Sixty-two developed 65 episodes of S. aureus bacteremia (1.2 episodes/100 patient-months). Complications occurred in 27 (44%) patients. Bacteremia recurred in patients who dialyzed through polytetrafluorethylene grafts (44.4% vs. 7.1%, P = 0.0.01), and there was a trend to increased recurrence in patients who received only vancomycin (19.5% vs. 7.1%, P = 0.4). IE was diagnosed in 8 patients (12%), six of whom had normal transthoracic echocardiograms. CONCLUSIONS: Sensitive echocardiographic techniques and the Duke criteria for the diagnosis of IE should be used to determine the proper duration of antibiotic therapy in hemodialysis patients with S. aureus bacteremia. This diagnostic approach, coupled with early removal of hardware, may assist in improving outcomes.

Duke Scholars

Published In

Kidney Int

DOI

ISSN

0085-2538

Publication Date

November 1998

Volume

54

Issue

5

Start / End Page

1684 / 1689

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Staphylococcal Infections
  • Renal Dialysis
  • Prospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Female
  • Endocarditis, Bacterial
 

Citation

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Marr, K. A., Kong, L., Fowler, V. G., Gopal, A., Sexton, D. J., Conlon, P. J., & Corey, G. R. (1998). Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int, 54(5), 1684–1689. https://doi.org/10.1046/j.1523-1755.1998.00134.x
Marr, K. A., L. Kong, V. G. Fowler, A. Gopal, D. J. Sexton, P. J. Conlon, and G. R. Corey. “Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients.Kidney Int 54, no. 5 (November 1998): 1684–89. https://doi.org/10.1046/j.1523-1755.1998.00134.x.
Marr KA, Kong L, Fowler VG, Gopal A, Sexton DJ, Conlon PJ, et al. Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int. 1998 Nov;54(5):1684–9.
Marr, K. A., et al. “Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients.Kidney Int, vol. 54, no. 5, Nov. 1998, pp. 1684–89. Pubmed, doi:10.1046/j.1523-1755.1998.00134.x.
Marr KA, Kong L, Fowler VG, Gopal A, Sexton DJ, Conlon PJ, Corey GR. Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int. 1998 Nov;54(5):1684–1689.
Journal cover image

Published In

Kidney Int

DOI

ISSN

0085-2538

Publication Date

November 1998

Volume

54

Issue

5

Start / End Page

1684 / 1689

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Staphylococcal Infections
  • Renal Dialysis
  • Prospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Female
  • Endocarditis, Bacterial