Bacteræmi: En ny kvalitetsindikator?

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This Power Point presentation belongs to the Danish Renal Registry, which owns the copyright. It can be freely used for non- commercial study and educational.

This Power Point presentation belongs to the Danish Renal Registry, which owns the copyright. It can be freely used for non-commercial study and educational.

This Power Point presentation belongs to the Danish Renal Registry, which owns the copyright. It can be freely used for non-commercial study and educational.

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Presentation transcript:

Bacteræmi: En ny kvalitetsindikator? Udtræk fra MiBi 1.1.2010-1.1.2014 3287 tilfælde hos 2127 patienter Alle patienter i DNSL 2010-2014 2677 incidente patienter 4937 prævalente patienter I alt 7614 patienter

Microbiology: First Bacteraemia Staphylococcus 46%

Microbiology: First and Fourth Bacteraemia

Time to first Bacteraemia Excess risk Excess Risk HD 12% RT 10% PD 0% Annual Risk HD 14% PD 9% RT 2% 6-month Incidence HD 18% PD 4% RT 14% Annual risk P<0.001

Planned vs. Unplanned HD Excess Risk AV Fistula 1% Permanent Tunneled 5% Temporary Tunneled 11% Temporary 18% Annual Risk AV Fistula 13% Permanent Tunneled 16% Temporary Tunneled 14% Temporary 13% P<0.001

Correlations to excess risk and annual rate of bacteraemia (1) Age DM % All patients Sex: No effect

Correlations to excess risk and annual rate of bacteraemia (2) Charlson Comorbidity Index Gram Stain % All patients

Patient survival after first bacteraemia Excess Risk HD 22% PD 14% Annual Risk HD 20% PD 11% P<0.01

Correlations to mortality after first bacteraemia (1) Access (HD patients only) Age (All patients) % Bacteraemia less than 6 months after ESRD Number needed to kill (NNK) Temporary 33 Temporary tunneled 70

Correlations to mortality after first bacteraemia (2) Charlson Comorbidity Index Gram stain, DM & Sex: No effect % All patients

Quality Indicators by Center 2010-14

Konklusioner Mulige indikatorer Incidens af første bacteræmi episode efter 6 måneder Incidens af alle episoder pr. patient/år delt efter behandlingsmodalitet (HD,PD,RT) Mortalitet efter 1. episode (alle dialysepatienter) Behov for komorbiditetsjustering (alder, CCI, DM)?

Microbiology: First and Second Bacteraemia

Microbiology: Third and Fourth Bacteraemia

HD Access and Gram Type Excess risk Annual rate HD only

6-month mortality after first bacteraemia by center All patients. Range 21-42% % Excess Risk 20% Annual Rate 22% 6-month mortality 33%

6 month bacteraemia incidence by Center HD only, first bacteraemia episode only Range 11-25% % Center

Bacteraemia incidence 2010-2014 by center HD only, all episodes Range 14-32% Denmark HD 21.3%/yr PD 7.6%/yr RT 5.6%/yr % Center

Planned vs. Unplanned PD No excess risk Planned 9%/yr Unplanned 13%/yr P<0.01

Calculation of Excess risk and Annual Risk A= Event-free survival at 0.5 years B= Event-free survival at 2.5 years Annual rate (%) = (1-(B/A)) x 100 Excess risk (%) = (1 - (B/A)0.25) x 100