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

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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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Acknowledgments

Dr. Manish M. Sood is supported by the Jindal Research Chair for the Prevention of Kidney Disease. Partial funding for this study was provided by the Manitoba Research Foundation, The Deacon Foundation, Astellas, Pfizer, and Astra-Zeneca. Dr. Sean M. Bagshaw is supported by Canada Research Chair in Critical Care Nephrology and an Independent Investigator Award from Alberta Innovates—Health Solutions.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Edward Clark, Amit Langote & Manish M. Sood

  2. Departments of Medicine, Medical Microbiology and Pharmacology, Section of Critical Care Medicine and Section of Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada

    Anand Kumar

  3. Section of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada

    Stephen Lapinsky

  4. Section of Critical Care Medicine, St. Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada

    Peter Dodek

  5. Section of Critical Care Medicine, Foothills Hospital and University of Calgary, Calgary, AB, Canada

    Andreas Kramer

  6. Section of Critical Care Medicine, Royal Jubilee Hospital/Victoria General Hospital and University of British Columbia, Victoria, BC, Canada

    Gordon Wood

  7. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Sean M. Bagshaw

  8. Section of Critical Care Medicine, Geisinger Medical Center, Danville, PA, USA

    Ken Wood

  9. Section of Critical Care Medicine, Rush Medical College, Chicago, IL, USA

    Dave Gurka

  10. Ottawa Hospital Research Institute, The Ottawa Hospital, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, P.O. Box 693, Ottawa, ON, K1Y 4E9, Canada

    Manish M. Sood

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  1. Edward Clark
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  2. Anand Kumar
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  3. Amit Langote
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  7. Gordon Wood
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  8. Sean M. Bagshaw
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  9. Ken Wood
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  10. Dave Gurka
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  11. Manish M. Sood
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The Cooperative Antimicrobial Therapy of Septic Shock Database Research Group

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Correspondence to Manish M. Sood.

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Additional information

Take-home message: Chronic dialysis patients admitted to the ICU with septic shock undergo time-varying survival, with early improved survival followed by similar or worse survival compared to non-dialysis patients. The former also differ from non-dialysis patients in terms of causative organisms, site of infection and delayed empiric antimicrobials. Improvements in timely antimicrobial therapy could optimize outcomes.

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Clark, E., Kumar, A., Langote, A. et al. Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality. Intensive Care Med 42, 222–232 (2016). https://doi.org/10.1007/s00134-015-4147-9

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