Higher access-associated bacteremia but less hospitalization among Saudi compared with US hemodialysis outpatients

Comparison of Saudi patients with chronic hemodialysis to an international benchmark was not performed before. We conducted a prospective surveillance study for all end-stage kidney disease patients served by the hemodialysis unit at King Abdulaziz Medical City (KAMC) in Riyadh, SA, between May 2008 and December 2009. US National Healthcare Safety Network (NHSN) definitions were used for comparison. Among 227 patients with adverse events, 55% were women and their age was 60.2 ± 20.2 years. Events recorded included 339 all-cause hospitalizations, 302 outpatient start of intravenous antimicrobials, and 174 access-associated bacteremias. In comparison with NHSN, hospitalization rate per 100 patient-months was lower (8.6 vs. 10.7, p < 0.001), rates of both antimicrobial start (7.6 vs. 3.5, p < 0.001) and access-associated bacteremia (4.4 vs. 1.3, p < 0.001) were higher, and blood cultures were more likely to grow gram-negative rods (47.9% vs. 21.3%, p < 0.001). Similar to NHSN, permanent catheter was associated with highest, while arterio-venous fistula was associated with lowest event rates, irrespective of event type. KAMC had 2-4 times higher rates of access-associated bacteremia and antimicrobial start as well as a higher catheter prevalence (42% vs. 31%). The lower hospitalization may indicate good control of comorbidities at outpatient level or underutilization of inpatient services.