Complications of Hemodialysis Catheter Bloodstream Infections: Impact of Infecting Organism

Abstract

Background: Catheter-related bloodstream infections ­(CRBSI) are associated with a high burden of morbidity and mortality, but the impact of infecting organism on clinical outcomes has been poorly studied. Methods: This retrospective analysis of a prospective vascular access database from a large academic dialysis center investigated whether the organism type affected the clinical presentation or complications of CRBSI. Results: Among 339 patients with suspected CRBSI, an alternate source of infection was identified in 50 (15%). Of 289 patients with CRBSI, 249 grew a single organism and 40 were polymicrobial. Fever and/or rigors were presenting signs in ≥90% of patients with Staphylococcus aureus or Gram-negative CRBSI, but only 61% of Staphylococcus epidermidis infections (p < 0.001). Hospitalization occurred in 67% of patients with S. aureus CRBSI versus 34% of those with S. epidermidis and 40% of those with a Gram-negative bacteria (p < 0.001). Admission to the intensive care unit was required in 14, 9, and 2% (p = 0.06); metastatic infection occurred in 10, 4, and 4% (p = 0.42); and median length of stay among patients admitted to the hospital was 4, 4, and 5.5 days (p = 0.60), respectively. Death due to CRBSI occurred in only 1% of patients with CRBSI. Conclusion: CRBSI is confirmed in 85% of catheter-dependent hemodialysis patients in whom it is suspected. S. epidermidis CRBSI tends to present with atypical symptoms. S. aureus CRBSI is more likely to require hospitalization or intensive care admission. Metastatic infection is relatively uncommon, and death due to CRBSI is rare.

Effects of different catheter replacement methods on catheter service time and complications in hemodialysis patients: A cohort study

“…19 With the absence of fibrin sheath formation, the incidence of subsequent catheter dysfunction and infection may decrease. 20 Catheter bacteremia is a serious complication that usually results in hospitalizations and deaths, 21 which occurred in 29% and 22.7% of patients undergoing ectopic and in situ catheter replacement. Some tunnel infections can be cured by antibiotics, while others may lead to estuation or replacement of catheters.…”

Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study

“…While it has been lately reported by Quinn et al, in one Canadian study, that CRBSIs culminated into death of 2.3% of their cohort, 39 Farrington and Allon affirmed that only 1% of the recorded mortality between their catheter-reliant hemodialysis patients was ascribed to CRBSI. 37 Recently, a substantively higher mortality rate up to 5% was specified by Martin et al 40 In contrast, although 2.16% of our hemodialysis patients died during the 2 years-study period, mortality could not be allocated directly to CRBSI, denoting that the use of hemodialysis catheters was not a leading cause of death per se amongst our cohort.…”

“…On top of that, admission to the ICU was mandatory in 26.2% of Gram-negative CRBSIs as opposed to 3.6% of CoNS- and 2.4% of S. aureus- associated CRBSIs ( p = 0.0001). Conversely, Al-Solaiman et al 36 and Farrington and Allon 37 noticed that the likelihood of hospitalization and ICU admission was highest with S. aureus , moderate with S. epidermidis , and least with Gram-negative CRBSIs.…”

“…Our observations are in conformity with the results of former studies. 37,38 It is important to address the fact that all of our infected patients received empiric systemic antibiotic therapy in the outpatient settings while waiting culture and sensitivity results (intravenous vancomycin and ceftazidime). When culture results returned back, their treatment was tailored to the reported sensitivity patterns.…”

Η Αξιολόγηση Των Χαρακτηριστικών Των Μονίμων Αγγειακών Καθετήρων Που Σχετίζονται Με Την Επανακυκλοφορία Και Τη Σημασία Της Στην Επάρκεια Της Παρεχόμενης Χρόνιας Περιοδικής Αιμοκάθαρσης

“…εισάγει το αίμα αντίθετα προς το «ρεύμα» από μία πλάγια οπή. Μελέτες in vitro έδειξαν απουσία επανακυκλοφορίας σε λειτουργία, τόσο με ορθά, όσο και με αντίστροφα σκέλη(56,57).Έχει φανεί ότι το 15% περίπου όλων των αιματογενών λοιμώξεων είναι πολυμικροβιακές(62). Η κλινική εικόνα φαίνεται να σχετίζεται με τον υπεύθυνο μικροοργανισμό.…”