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Outcomes of Staphylococcus aureus Infection in Hemodialysis-Dependent Patients

Yanhong Li^*, Joëlle Y. Friedman^*, Betsy F. O'Neal^*, Matthew J. Hohenboken, Robert I. Griffiths, Martin E. Stryjewski^*,, John P. Middleton^||, Kevin A. Schulman^*,||, Jula K. Inrig^||,¶, Vance G. Fowler, Jr^*,||, and Shelby D. Reed^*,||

^* Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Nabi Biopharmaceuticals, Rockville, Maryland; Health Economics Consulting, Craftsbury, Vermont; Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina; ^|| Department of Medicine, Duke University School of Medicine, Durham, North Carolina; ^¶ Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, Texas

Correspondence: Dr. Shelby D. Reed, Center for Clinical and Genetic Economics, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. Phone: 919-668-8101; Fax: 919-668-7124; E-mail: shelby.reed{at}duke.edu

Background and objectives: Staphylococcus aureus is a leading cause of infection in patients with ESRD. Clinical and economic outcomes associated with S. aureus bacteremia and other S. aureus infections in patients with ESRD were examined.

Design, setting, participants, & measurements: Laboratory, clinical, and hospital billing data from a randomized trial of 3359 hemodialysis-dependent patients hospitalized with S. aureus infection in the United States whose vascular access type was fistula or graft and who were hospitalized with S. aureus infection to evaluate inpatient costs, hospital days, and mortality over 12 wk were used. Generalized linear regression was used to identify independent predictors of 12-wk costs, inpatient days, and mortality.

Results: Of the 279 patients (8.3%) who developed S. aureus infection during approximately 1 yr of follow-up, 25.4% were treated as outpatients. Among patients for whom billing data were available, 89 patients hospitalized with S. aureus bacteremia incurred mean 12-wk inpatient costs of $19,454 and 11.9 inpatient days. Among the 70 patients hospitalized with non-bloodstream S. aureus infections, mean inpatient costs were $19,222 and the mean number of inpatient days was 11.3. Twelve-week mortality was 20.2 and 15.7% for patients with S. aureus bloodstream and non-bloodstream infections, respectively. Older age was independently associated with higher risk of death among patients with S. aureus bacteremia and with higher inpatient costs and more hospital days among patients with non-bloodstream infections.

Conclusions: Hemodialysis-dependent patients with fistula or graft access incur high costs and long inpatient stays when hospitalized for S. aureus infection.