Bacteraemia in Patients on Kidney Replacement Therapy: A 4-Year Single-Centre Experience

Background: Infection is a common cause of morbidity and mortality in patients on renal replacement therapy (RRT). The majority of bacteraemias in haemodialysis (HD) patients are related to the vascular access. We decided to look at our dialysis cohort to see whether there was a difference in the incidence and types of bacteraemias based on the type of HD access and what the annual trends were over the last 4 years. Methods: Retrospective review of patients on RRT who had bacteraemias between May 2019 to March 2024. Data collected included RRT type, blood culture results and dialysis access. Statistical analysis was done with Microsoft Excel. Results: There were 501 bacteraemias, 435 (87%) were from patients undergoing HD. Median age was 67 years (range 19-91). The HD population rose from 872 to 982 between 2019 and 2023. The bacteraemias fell over this period from 0.36 to 0.23 bacteraemias per 1,000 patient days (figure 1). Micro-organisms isolated from HD patients were gram positive 336 (77%), and Gram negative 88(20%). Of the Gram positive organisms, 28(6.4%) were Enterococci; 275 (63%), were staphylococci [MSSA - 105 (24%) MRSA - 8 (1.8%) coagulase negative - 161 (37%)]. Dialysis access related bacteraemias were as follows: AV fistula/graft 58(13%), Tunnelled dialysis lines 332 (76 %), non-tunnelled dialysis lines 35 (8%). Conclusion: In this cohort of patients, bacteremias were more common in HD patients. The predominant organisms isolated were Gram positive and the majority of these were coagulase negative staphylococci. The incidence of MRSA was one tenth that of MSSA. Bacteraemias were much more likely to occur in patients dialysing through lines as compared with AV fistulae or grafts. This lends weight to the drive to increase the proportion of patients dialysing through AVFs or AVGs.