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01-02-2016 | Original

Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality

Authors: Edward Clark, Anand Kumar, Amit Langote, Stephen Lapinsky, Peter Dodek, Andreas Kramer, Gordon Wood, Sean M. Bagshaw, Ken Wood, Dave Gurka, Manish M. Sood, The Cooperative Antimicrobial Therapy of Septic Shock Database Research Group

Published in: Intensive Care Medicine | Issue 2/2016

Abstract

Objectives

To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney disease patients with septic shock in comparison to septic shock patients not receiving chronic dialysis.

Methods

Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death.

Results

Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients.

Conclusions

The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis.

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Title: Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality
Authors: Edward Clark
Anand Kumar
Amit Langote
Stephen Lapinsky
Peter Dodek
Andreas Kramer
Gordon Wood
Sean M. Bagshaw
Ken Wood
Dave Gurka
Manish M. Sood
The Cooperative Antimicrobial Therapy of Septic Shock Database Research Group
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-4147-9

2024 ASCO Annual Meeting

Springer Medicine

Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality

Abstract

Objectives

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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