Udtræk fra MiBi 112010112014 3287 tilfælde hos 2127 patienter Alle patienter i DNSL 20102014 2677 incidente patienter 4937 prævalente patienter I alt 7614 patienter Microbiology ID: 802180
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Slide1
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
Slide2Microbiology
: First
Bacteraemia
Staphylococcus
46%
Slide3Microbiology: First and Fourth
Bacteraemia
Slide4Time to first
Bacteraemia
Excess
Risk
HD 12%
RT 10%
PD 0%
Annual
Risk
HD 14%
PD 9%
RT 2%6-month IncidenceHD 18%PD 4%RT 14%
P<0.001
Excess
risk
Annual
risk
Slide5Planned
vs.
Unplanned HD
Excess
Risk
AV
Fistula
1%
Permanent
Tunneled
5%
Temporary
Tunneled 11%Temporary 18%Annual RiskAV
Fistula 13%Permanent Tunneled 16%Temporary
Tunneled 14%Temporary 13%
P<0.001
Slide6Correlations to excess
risk and
annual rate of bacteraemia (1)Age
DM
%
All patients
Sex: No
effect
Slide7Correlations
to
excess
risk and annual rate of bacteraemia (2)Charlson Comorbidity Index
Gram
Stain
%
All patients
Slide8Patient survival
after
first
bacteraemia
Excess
Risk
HD 22%
PD 14%
Annual
Risk
HD 20%
PD 11%
P<0.01
Slide9Correlations 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 33Temporary tunneled
70
Slide10Correlations
to
mortality
after first bacteraemia (2)Charlson Comorbidity Index
%
All patients
Gram
stain
, DM & Sex: No
effect
Slide11Quality Indicators
by Center 2010-14
Slide12Konklusioner
Mulige indikatorer
Incidens
af første bacteræmi episode efter 6 månederIncidens af alle episoder pr. patient/år delt efter behandlingsmodalitet (HD,PD,RT)Mortalitet efter 1. episode (alle dialysepatienter)
Behov for
komorbiditetsjustering
(alder, CCI, DM)?
Slide13Microbiology: First and Second
Bacteraemia
Slide14Microbiology: Third and Fourth
Bacteraemia
Slide15HD Access and Gram Type
Excess
risk
Annual
rate
HD only
Slide166-month mortality
after
first bacteraemia by center
All patients.
%
Range 21-42%
Excess
Risk
20%
Annual
Rate 22%
6-month
mortality 33%
Slide176 month
bacteraemia
incidence
by Center
HD
only
,
first bacteraemia episode only
%
Center
Range 11-25%
Slide18Bacteraemia incidence
2010-2014 by center
HD
only
, all episodes
%
Denmark
HD 21.3%/
yr
PD 7.6%/
yr
RT 5.6%/
yr
Center
Range 14-32%
Slide19Planned
vs.
Unplanned PD
No
excess
risk
Planned
9%/
yr
Unplanned
13%/
yr
P<0.01
Slide20Calculation of Excess
risk and
Annual RiskA= Event-free survival at 0.5
years
B= Event-
free
survival at 2.5 yearsAnnual rate (%) = (1-
(B/A)) x 100
Excess
risk
(%) = (1 - (B/A)0.25) x 100
Slide21