OBJECTIVES: Despite advances in infection control and catheter care, central venous catheter (CVC)-related S. aureus bloodstream infections (SA-BSI) rates in adult patients on hemodialysis using a CVC (CVC-HD) remains high, especially among CVC-HD patients with SA nares colonization. This study sought to estimate the yearly costs associated with CVC-related SA-BSIs in adult CVC-HD patients with SA nares colonization.

METHODS: A probabilistic model from the US Healthcare Perspective over a 1-year time horizon was developed. The study population consisted of ~90,000 patients who start in-center CVC-HD per year (United States Renal Data System (USRDS)). Markov modeling (four 12-week cycles) was used to simulate transitions between different health-related dynamic states of CVC-HD patients (CVC, CVC with prior SA-BSI, death, and CVC removal) and estimate the frequency of CVC-related SA-BSI-related outcomes over 1-year period. The time on CVC among incident CVC-HD patients over 1 year (USRDS), presence of SA nasal colonization among CVC-HD patients (40%), frequency of CVC-related SA-BSIs among SA colonized CVC-HD patients (2.5 CVC-related SA-BSIs per 100 person-months), 12-week SA-BSI-related costs ($47,285), SA-BSI relapse rate among SA-BSI survivors (15%), and SA-BSI relapse costs ($42,352) were identified through a comprehensive literature search. Analyses were performed in TreeAge Pro Healthcare.

RESULTS: Data indicate 36,000 of the 90,000 annual incident CVC-HD patients are colonized with SA in their nares. Among SA nares colonized CVC-HD patients, the model estimates that there are ~6,300 CVC-related SA-BSIs, 1,170 SA-BSI relapses, and 960 SA-BSI-related deaths annually. Attributable costs associated with SA-BSI in CVC-HD patients with SA nares colonization are projected to be $350 million annually.

CONCLUSION: Annual morbidity, mortality, and healthcare costs associated with CVC-related SA-BSIs in SA nares colonized CVC-HD patients are substantial. Interventions designed at preventing CVC-related SA-BSIs in SA nares colonized CVC-HD patients are sorely needed to minimize the deleterious outcomes associated with CVC-related SA-BSIs.