Dagasso, Gabrielle

Background: Bloodstream infections (BSI) commonly complicate end-stage renal disease (ESRD) and are the second most common cause of death in these patients. The objective of this study was to define risk factors for development of BSI and its outcome among ESRD patients. Methods: A retrospective, population-based, matched cohort design was utilized. All adult (18 or older) residents of the western interior of British Columbia with ESRD who had a first BSI between April 2010 and March 2017 were included. Subject cases were then matched 1:1 with an ESRD patient from the regional registry who did not have a BSI. Results: During the study period a total of 53 cases of incident BSI were identified among patients with ESRD. The median age was 70.7 (interquartile range, 61.9–79.6) years and 28 (53%) were male. The most common organism isolated was Staphylococcus aureus (17 cases; 32%). Compared to controls, case patients were significantly (p < .05) more likely to have higher Charlson comorbidity scores (mean difference (MD): 1.4; 95% CI (0.5, 2.2)), and have lower serum albumin (MD: −3.3; 95% CI (−5.5, −1.2)). Diabetes was not significant; however, cases were twice as likely to be diabetic (OR: 2.0; 95% CI (0.9, 4.8)). Case fatality rates for 30- and 90-days were 8/53 (15%) and 13/53 (25%) respectively, whereas no control patients died (p < .05). Conclusions: ESRD patients with higher co-morbid illness, and lower serum albumin are at an increased risk for development of a BSI. Development of BSI among ESRD patients is associated with higher fatality rates.

Background: The epidemiology of Streptococcus anginosus group (SaG) bloodstream infections (BSI) has not been well defined in non-selected populations. The objective of this study was to determine the incidence, risk factors and outcome associated with SaG BSI. Methods: Population-based surveillance was conducted in the western interior region of British Columbia, Canada between 1 April 2010 and 31 March 2017. Results: Forty-six episodes were identified for an overall annual incidence of 3.7 per 100,000 population. The incidence increased with older age and males were at significantly higher risk (5.2 vs. 2.1 per 100,000; incidence rate ratio, 2.5; 95% confidence interval, 1.3–5.1; p = .004). Nearly one-half (22; 48%) of patients had no chronic co-morbid illness, whereas 17 (40%) had 1–2, six (13%) had 3–4 and one (2%) had 5 Charlson scores with diabetes and cancer being the most common. Predisposing factors for development of SaG BSI were identified in 30 (65%) cases. The gastro-intestinal tract was the most common focus of infection (13; 28%) followed by cardiovascular and skin/soft tissue (six cases each; 13%) and in seven (15%) cases no focus was identified. Drainage procedures were required in 21 (46%) patients of whom seven (15%) patients had percutaneous drains and 14 (30%) required surgical operations. Forty-one (89%) patients were admitted to hospital for a median hospital length stay of 11 (interquartile range, 7–18) days. The in-hospital and 30-day all cause case-fatality rates were 3/41 (7%) and 4/46 (9%), respectively. Conclusion: SaG BSI is an important cause of morbidity and mortality.