title: Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality.
abstract: OBJECTIVE
  To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney disease patients with septic shock in comparison to septic shock patients not receiving chronic dialysis.
  
  
  METHODS
  Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death.
  
  
  RESULTS
  Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients.
  
  
  CONCLUSIONS
  The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis.
authors.affiliation: Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Clark
authors.affiliation: Departments of Medicine, Medical Microbiology and Pharmacology, Section of Critical Care Medicine and Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Amit
authors.initials: A
authors.lastname: Langote
authors.affiliation: Section of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lapinsky
authors.affiliation: Section of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.affiliation: Section of Critical Care Medicine, Foothills Hospital and University of Calgary, Calgary, AB, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kramer
authors.affiliation: Section of Critical Care Medicine, Royal Jubilee Hospital/Victoria General Hospital and University of British Columbia, Victoria, BC, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Wood
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Section of Critical Care Medicine, Geisinger Medical Center, Danville, PA, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Wood
authors.affiliation: Section of Critical Care Medicine, Rush Medical College, Chicago, IL, USA.
authors.forename: Dave
authors.initials: D
authors.lastname: Gurka
authors.affiliation: Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. msood99@gmail.com.|Ottawa Hospital Research Institute, The Ottawa Hospital, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, P.O. Box 693, Ottawa, ON, K1Y 4E9, Canada. msood99@gmail.com.
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002908:Chronic Disease / Q000188:drug therapy / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality*
chemical_list: D000890:Anti-Infective Agents
keywords: Antimicrobials; Dialysis; Dialysis modality; Epidemiology; In-hospital mortality; Kidney failure; Septic shock