Clinical outcomes and costs due to Staphylococcus aureus bacteremia among patients receiving long-term hemodialysis.
OBJECTIVE
To examine the clinical outcomes and costs associated with Staphylococcus aureus bacteremia among hemodialysis-dependent patients.


METHODS
Prospectively identified cohort study.


METHODS
A tertiary-care university medical center in North Carolina.


METHODS
Two hundred ten hemodialysis-dependent adults with end-stage renal disease hospitalized with S. aureus bacteremia.


RESULTS
The majority of the patients (117; 55.7%) underwent dialysis via tunneled catheters, and 29.5% (62) underwent dialysis via synthetic arteriovenous fistulas. Vascular access was the suspected source of bacteremia in 185 patients (88.1%). Complications occurred in 31.0% (65), and the overall 12-week mortality rate was 19.0% (40). The mean cost of treating S. aureus bacteremia, including readmissions and outpatient costs, was $24,034 per episode. The mean initial hospitalization cost was significantly greater for patients with complicated versus uncomplicated S. aureus bacteremia ($32,462 vs $17,011; P = .002).


CONCLUSIONS
Interventions to decrease the rate of S. aureus bacteremia are needed in this high-risk, hemodialysis-dependent population.
Engemann
John J
JJ
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. john.engemann@duke.edu
Friedman
Joelle Y
JY
Reed
Shelby D
SD
Griffiths
Robert I
RI
Szczech
Lynda A
LA
Kaye
Keith S
KS
Stryjewski
Martin E
ME
Reller
L Barth
LB
Schulman
Kevin A
KA
Corey
G Ralph
GR
Fowler
Vance G
VG
D000046:Academic Medical Centers; D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D016470:Bacteremia / Q000191:economics* / Q000209:etiology / Q000401:mortality; D017281:Cost of Illness; D003428:Cross Infection / Q000191:economics* / Q000209:etiology / Q000401:mortality; D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010359:Patient Readmission / Q000191:economics; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000191:economics* / Q000209:etiology / Q000401:mortality; D013211:Staphylococcus aureus; D016896:Treatment Outcome