Burden of haemodialysis catheter-related bloodstream infections in Australia: a national data-linkage study.

Abstract

Background: Haemodialysis catheters are widely used and prone to infection, but the health impact of these infections is unknown. We aimed to quantify the health burden of haemodialysis catheter-related bloodstream infection (HDCRBSI) among chronic haemodialysis patients in Australia. Method(s): Patients who commenced chronic haemodialysis via a catheter in the REDUCCTION trial (Dec 2016- Mar 2020) were followed from first catheter insertion to the later of final catheter removal or end of the trial. Hospitalizations in all States and Territories (except WA) were probabilistically linked and classified using the principal ICD10-AM diagnostic code. Same-day admissions were excluded. Hospitalizations for vascular access infection (VAI) or bacteraemia, with concurrent HDCRBSI reported at time of admission, were characterized. Result(s): In REDUCCTION, 4004 patients commenced chronic haemodialysis via a catheter and were followed for 968,783 days, with baseline characteristics comparable to the Australian haemodialysis population. Infection was coded as the primary reason for admission in 1838 (18.1%) of 10,154 non-same-day hospitalizations and accounted for 18,982 (24.1%) of 78,696 total days in hospital. Mean duration of hospitalization for VAI (3649 total bed days, 377 admissions) and bacteraemia (5981 total bed days, 391 admissions) were longer than for pneumonia (2183 total bed days, 361 admissions) or cellulitis (1535 total bed days, 139 admissions; all p<0.01). Concurrent HDCRBSI at time of hospitalization was reported in 148 admissions, 122 (82%) with primary code for VAI or bacteraemia. The median length of stay was 9 days (IQR 5-15), 19 (15.6%) admissions required intensive care (median 64 hours, IQR 27 - 110), 10 (8.2%) were complicated by metastatic infection, and 4 (3.3%) resulted in death. Conclusion(s): Catheter-related infections are a major source of infectious hospitalization among Australians receiving chronic haemodialysis via a catheter.