title: Risk and Prognosis of Bacteremia and Fungemia Among Peritoneal Dialysis Patients: A Population-Based Cohort Study.
abstract: ♦ BACKGROUND: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ OBJECTIVE: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. ♦ METHODS: Design: Observational cohort study.
  
  
  METHODS
  Central and North Denmark regions.
  
  
  METHODS
  patients who initiated PD during 1995 - 2010. For each patient we sampled up to 10 controls from the general population matched on age, sex, and municipality. ♦ MAIN OUTCOME: Data on positive blood cultures were retrieved from electronic microbiology databases covering the 2 regions. We calculated incidence rates (IRs) of first-time BAF for PD patients and population controls. Incidence-rate ratios (IRRs) were calculated to compare these rates. Thirty-day mortality was estimated by Kaplan-Meier analysis. ♦ RESULTS: Among 1,024 PD patients and 10,215 population controls, we identified 75 and 282 episodes of BAF, respectively. Incidence rates of BAF were 4.7 (95% confidence interval [CI], 3.8 - 5.9) per 100 person-years of follow-up (PYFU) in PD patients and 0.5 (95% CI, 0.4 - 0.5) per 100 PYFU in population controls (IRR = 10.4; 95% CI, 8.1 - 13.5). In PD patients, the most frequent microorganisms were Escherichia coli (18.7%) and Staphylococcus aureus (13.3%). Escherichia coli (27.3%) also ranked first among population controls. Thirty-day mortality following BAF was 20.8% (95% CI, 12.6 - 31.0) and 20.7% (95% CI, 16.3 - 25.9) among PD patients and population controls, respectively. ♦ CONCLUSIONS: Peritoneal dialysis patients are at markedly higher risk of BAF than population controls. Causative agents and the 30-day post-BAF mortality were similar in the 2 cohorts.
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Denmark larsdalg@rm.dk.
authors.forename: Lars Skov
authors.initials: LS
authors.lastname: Dalgaard
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Nørgaard
authors.affiliation: Department of Nephrology, Aarhus University Hospital, Denmark.
authors.forename: Johan Vestergaard
authors.initials: JV
authors.lastname: Povlsen
authors.affiliation: Department of Nephrology, Aarhus University Hospital, Denmark.
authors.forename: Bente
authors.initials: B
authors.lastname: Jespersen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Jensen-Fangel
authors.affiliation: Department of Clinical Microbiology, Aarhus University Hospital, Denmark.
authors.forename: Svend
authors.initials: S
authors.lastname: Ellermann-Eriksen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: Department of Clinical Microbiology, Aalborg University Hospital, Denmark.|Department of Clinical Medicine, Aalborg University, Denmark.
authors.forename: Henrik Carl
authors.initials: HC
authors.lastname: Schønheyder
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Denmark.
authors.forename: Ole Schmeltz
authors.initials: OS
authors.lastname: Søgaard
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003718:Denmark; D005260:Female; D016469:Fungemia / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: Bacteremia; fungemia; peritoneal dialysis; prognosis; risk