Sinclair MR, Souli M, Ruffin F, et al. - Researchers conducted a prospective cohort study with the aim to determine the changes in clinical and bacterial characteristics, and their relationships with clinical outcomes following Staphylococcus aureus (S. aureus) bacteremia (SAB) in patients receiving maintenance hemodialysis (HD) over a 21-year period. Among 453 hospitalized, non-neutropenic, adults receiving maintenance HD who developed monomicrobial SAB, they noted significant increases in age- and diabetes-adjusted SAB-attributable mortality, persistent bacteremia, metastatic infection complications, and infection with the virulent S. aureus clone USA300 over the 21-year study period. Over time, a central venous catheter or arteriovenous (AV) graft is less frequently, but a non-vascular access source is more frequently identified to be the source of SAB. Findings overall suggest that there have been changes in terms of the clinical and molecular epidemiology of SAB in HD-dependent patients, with an increase in SAB-attributable mortality and morbidity despite a reduction in catheter-related infections.