WHAT ARE THE INFECTIONS THAT AUSTRALIANS ON RENAL REPLACEMENT THERAPY DIE FROM?

A GRAVER¹, S KUO¹, L COOLEY², N ABEYSEKERA³, G KIRKLAND¹, MD JOSE^1,3,4

¹Renal Unit, Royal Hobart Hospital, Tasmania; ²Infectious Diseases Unit, Royal Hobart Hospital, Tasmania;  ³School of Medicine, University of Tasmania; ⁴Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)

Aim: To examine the location and type of infection leading to death in Australians treated with dialysis or kidney transplantation, with a focus on vaccine-preventable diseases (VPDs) and multi-resistant organisms (MROs).

Background: People treated with renal replacement therapy (RRT) suffer frequent infections with repetitive administration of antibiotics, recurrent admissions and high incidence of MROs. VPDs may occur due to suboptimal vaccination rates and vaccine-responsiveness.

Methods: We reviewed Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) from 1/1/2000 to 31/12/2015 for all Australian deaths reported due to infection. VPDs were defined per the Australian Immunisation Handbook 10^th Edition 2013. MROs were defined per National Health and Medical Research Council guidelines.

Results: Over 16 years, 2833 people died of infection (44% female, mean age 66.3yrs). The majority of infections occurred in patients treated with haemodialysis (HD) (1920 deaths), followed by peritoneal dialysis (588), then kidney transplantation (325). Most deaths were due to bacterial infections, reported as bacterial septicaemia, lung, peritoneal or wound infections. VPDs were responsible for 70 deaths, the majority in HD (46) despite a higher proportion in transplants (2.4% vs 4.6%, respectively), and included deaths related to influenza (19), varicella zoster (12) and invasive Pneumococcus (28). Whilst MROs were responsible for 177 deaths, those due to methicillin-resistant Staphylococcus aureus more than halved between 2000-4 to 2010–2015. Vancomycin-resistant Enterococcus, extended spectrum beta lactamase producing organisms and Acinetobacter infections all increased over the period of the study; Clostridium difficile infections increased 4-fold.

Conclusions: Infectious deaths are commonly due to bacterial infections in people treated with RRT. Specific MROs are becoming more frequent and targeted management is required. Some deaths may be preventable by appropriate vaccination.