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Bacteræmi: En ny kvalitetsindikator?

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Presentation on theme: "Bacteræmi: En ny kvalitetsindikator?"— Presentation transcript:

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

2 Microbiology: First Bacteraemia
Staphylococcus 46%

3 Microbiology: First and Fourth Bacteraemia

4 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

5 Planned vs. Unplanned HD
Excess Risk AV Fistula % Permanent Tunneled 5% Temporary Tunneled % Temporary % Annual Risk AV Fistula % Permanent Tunneled % Temporary Tunneled 14% Temporary % P<0.001

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

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

8 Patient survival after first bacteraemia
Excess Risk HD % PD % Annual Risk HD % PD % P<0.01

9 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

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

11 Quality Indicators by Center 2010-14

12 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)?

13 Microbiology: First and Second Bacteraemia

14 Microbiology: Third and Fourth Bacteraemia

15 HD Access and Gram Type Excess risk Annual rate HD only

16 6-month mortality after first bacteraemia by center
All patients. Range 21-42% % Excess Risk 20% Annual Rate 22% 6-month mortality 33%

17 6 month bacteraemia incidence by Center
HD only, first bacteraemia episode only Range 11-25% % Center

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

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

20 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

21

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