N RAO1, W LAU1, K WONG1, V VENKATARAMAN1
1Department of Nephrology, Peninsula Health, Frankston, Australia
Background: Infection is the second most common cause of mortality in haemodialysis (HD) patients. HD is a significant risk factor for infective endocarditis (IE). We performed a descriptive audit to study various factors that impacted HD patients with bacteraemia and their course.
Aims and Methods: We aimed to study the occurrence of bacteraemia, IE, number of days spent in hospital and the role of trans-oesophageal echocardiograms (TOE) in this cohort. We studied these by obtaining retrospective data using ICD-coding and electronic medical records.
Results: In our study over 3 years (Feb 2015 to Feb 2018), we identified 32 episodes of bacteraemia, out of which 1 patient had infective endocarditis. Of the bacteraemic patients 53.1% had permacath, 43.8% had AV fistula and 3.1% had an AV graft. More than 50% of bacteraemia were due to Staphylococcal species (31.1% coagulase negative and 25% Aureus). 15.6% patients had Enterococcus species. The remaining 28.3% of bacteraemia were other organisms (Enterobacter, Escherichia coli etc.) One patient with Enterococcus bacteraemia had a diagnosis of IE. Bacteraemic HD patients spent an average of 27 days (range 3-60) in hospital. The average time in our centre spent waiting for a trans-thoracic echocardiogram (TTE) was 4.9 days (0-22 days) and for a TOE was 9.3 days (0-25 days).
Conclusion: In this single-centre study, HD patients with bacteraemia had a prolonged length of stay that maybe due to prolonged waiting times for TTE and TOEs. These investigations lead to the diagnosis of IE in 1 patient. Further prospective studies are required to study the utility of TTE’s and TOE’s in non-staphylococcal and non-enterococcus bacteraemic HD patients with unclear source.
I am final year renal advanced trainee with special interests in home therapies and supportive care. I am also a general physician with an interest in perioperative medicine. Apart from medicine, I enjoy skiing, making terrariums and propagating indoor plants.