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Clinical Outcomes and Costs Due to Staphylococcus aureus Bacteremia Among Patients Receiving Long-Term Hemodialysis

  • John J. Engemann (a1), Joëlle Y. Friedman (a2) (a3), Shelby D. Reed (a2) (a3), Robert I. Griffiths (a4), Lynda A. Szczech (a5) (a3), Keith S. Kaye (a1), Martin E. Stryjewski (a1) (a3), L. Barth Reller (a1) (a6), Kevin A. Schulman (a2) (a3), G. Ralph Corey (a1) (a3) and Vance G. Fowler (a1) (a3)...



To examine the clinical outcomes and costs associated with Staphylococcus aureus bacteremia among hemodialysis-dependent patients.


Prospectively identified cohort study.


A tertiary-care university medical center in North Carolina.


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


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).


Interventions to decrease the rate of S. aureus bacteremia are needed in this high-risk, hemodialysis-dependent population (Infect Control Hosp Epidemiol 2005;26:534-539).


Corresponding author

Box 3038, Duke University Medical Center, Durham, NC


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1.Weinstein, MP, Towns, ML, Quartey, SM, et al.The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584602.
2.Steinberg, JP, Clark, CC, Hackman, BO. Nosocomial and community-acquired Staphylococcus aureus bacteremias from 1980 to 1993: impact of intravascular devices and methicillin resistance. Clin Infect Dis 1996;23:255259.
3.Lowy, FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520532.
4.Banerjee, SN, Emori, TG, Culver, DH, et al.Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. Am J Med 1991;91(suppl):86S89S.
5.Jensen, AG, Espersen, F, Skinhoj, P, Rosdahl, VT, Frimodt-Moller, N. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980-1990. J Infect 1997;34:113118.
6.Fernandez-Guerrero, ML, Verdejo, C, Azorra, J, de Gorgolas, M. Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem. Clin Infect Dis 1995;20:1623.
7.Fowler, VG Jr, Olsen, MK, Corey, GR, et al.Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003; 163:20662072.
8.Sexton, DJ. Vascular access infections in patients undergoing dialysis with special emphasis on the role and treatment of Staphylococcus aureus. Infect Dis Clin North Am 2001;15:731742.
9.Quarles, LD, Rutsky, EA, Rostand, SG. Staphylococcus aureus bacteremia in patients on chronic hemodialysis. Am J Kidney Dis 1985;6:412419.
10.Marr, KA, Sexton, DJ, Conlon, PJ, Corey, GR, Schwab, SJ, Kirkland, KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997;127:275280.
11.Kessler, M, Hoen, B, Mayeux, D, Hestin, D, Fontenaille, C. Bacteremia in patients on chronic hemodialysis: a multicenter prospective survey. Nephron 1993;64:95100.
12.Jean, G, Charra, B, Chazot, C, et al.Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias. Nephron 2002;91:399405.
13.Hoen, B, Paul-Dauphin, A, Hestin, D, Kessler, M. EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol 1998;9:869876.
14.Marr, KA, Kong, L, Fowler, VG, et al.Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int 1998;54:16841689.
15.Fowler, VG Jr, Kong, LK, Corey, GR, et al.Recurrent Staphylococcus aureus bacteremia: pulsed-field gel electrophoresis findings in 29 patients. J Infect Dis 1999; 179:11571161.
16.Hartstein, AI, Mulligan, ME, Morthland, VH, Kwok, RY. Recurrent Staphylococcus aureus bacteremia. J Clin Microbiol 1992;30:670674.
17.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408411.
18.Rubin, RJ, Harrington, CA, Poon, A, Dietrich, K, Greene, JA, Moiduddin, A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis 1999;5:917.
19.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.
20.Libman, H, Arbeit, RD. Complications associated with Staphylococcus aureus bacteremia. Arch Intern Med 1984;144:541545.
21.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864874.
22.Aronin, SI, Peduzzi, P, Quagliarello, VJ. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 1998;129:862869.
23.Durack, DT, Lukes, AS, Bright, DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1994;96:200209.
24.U.S. Department of Labor, Bureau of Labor Statistics. Bureau of Labor Statistics Data. Washington, DC: U.S. Department of Labor; 2004. Available at Accessed March 9, 2004.
25.Thompson, SG, Barber, JA. How should cost data in pragmatic randomised trials be analysed? BMJ 2000;320:11971200.
26.Blough, DK, Ramsey, SD. Using generalized linear models to assess medical costs. Health Services & Outcomes Research Methodology 2000;1:185202.
27.O'Brien, BJ, Heyland, D, Richardson, WS, Levine, M, Drummond, MF. Users' guides to the medical literature: XIII. How to use an article on economic analysis of clinical practice. B. What are the results and will they help me in caring for my patients? JAMA 1997;277:18021806.
28.Mermel, LA, Farr, BM, Sherertz, RJ, et. al.Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:12491272.
29.Shinefield, H, Black, S, Fattom, A, et al.Use of a Staphylococcus aureus conjugate vaccine in patients receiving hemodialysis. N Engl J Med 2002;346:491496.
30.Perl, TM, Cullen, JJ, Wenzel, RP, et al.Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002; 346:18711877.
31.United States Renal Data System. United States Renal Data System. Minneapolis, MN: United States Renal Data System; 2004. Available at Accessed March 9, 2004.
32.Xue, JL, Ma, JZ, Louis, TA, Collins, AJ. Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol 2001;12:27532758.
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Infection Control & Hospital Epidemiology
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  • EISSN: 1559-6834
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