Microrganismos isolados de pacientes em hemodiálise por cateter venoso central e evolução clínica relacionada

BackgroundInfection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.MethodsRisk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.ResultsThere were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09).ConclusionsInfection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

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“…Gram-positive bacteria are the most frequently isolated agents in blood cultures from hemodialysis patients, mainly S. aureus [7,10,11]. …”

Section: Introductionmentioning

confidence: 99%

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

et al. 2015

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“…Most authors have shown that, among the microorganisms isolated in blood cultures of hemodialysis patients, 28–65% are Gram positive, and Staphylococcus aureus is the most frequent, and ∼ 45% are Gram negative [9–11]. Gram-positive microorganisms, mainly S. aureus , are associated with higher rates of mortality; primarily when resistant to methicillin (methicillin-resistant S. aureus ; MRSA).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case–control study

et al. 2014

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BackgroundInfection is the leading cause of morbidity and the second most frequent cause of mortality among patients on renal replacement therapy. A major morbid event in this population is hospitalization because of infection. The aim of this study was to investigate the risk factors for morbidity and mortality related to bloodstream infection (BSI) among patients on hemodialysis.ResultsRisk factors for morbidity and mortality related to BSI in patients on hemodialysis were investigated retrospectively by nested case–control, from January 2010 to June 2013. Patients were divided into two groups: those who progressed to hospitalization or death due to BSI (Group 1) and those who developed BSI, but did not progress to the same outcome (Group 2). Data were collected through consultation of patient records. For statistical analysis, logistic regression was used. There were 32 patients in Group 1 and 61 in Group 2. Logistic regression verified that, for each year of age, the chance of death or hospitalization for BSI increased 1.05 times [95% confidence interval (CI): 1.02–1.09]. Patients with BSI caused by Staphylococcus aureus had an 8.67 times higher chance of progressing to death or hospitalization (95% CI: 2.5–30.06). The isolation of multiresistant microorganisms in blood cultures of hemodialysis patients increased morbidity and mortality by 2.75 times (95% CI: 1.01–7.48).ConclusionIndependent risk factors for morbidity and mortality among patients after developing BSI during hemodialysis were: age, blood culture positive for S. aureus, and antibiotic resistance. Control measures to prevent microbial dissemination, primarily the multiresistant ones, should be intensified in this population. More studies are needed to standardize specific measures not yet classically standardized, such as collection of surveillance culture samples, contact precautions, and decolonization.

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“…Utilizou (1) . Pacientes em UTI têm múltiplos acessos ao CVC por dia, o que aumenta o risco de contaminação e subsequente infecção.…”

Section: Metodologiaunclassified

“…O objetivo deste estudo foi evidenciar a conduta preventiva de maior impacto para a redução dos riscos de infecção do cateter venoso central (CVC). As infecções de corrente sanguínea (ICS) estão relacionadas ao uso CVC e compreendem os casos em que o mesmo microrganismo isolado na cultura do dispositivo é identificado na corrente sanguínea, sem outra fonte aparente para a bacteremia (1)(2)(3)(4)(5)(6)(7)(8) . A ampla utilização do CVC expõe os pacientes a infecções relacionadas ao seu uso e estas infecções apresentam significativos níveis de morbidade e mortalidade, associados principalmente à infecção causada pelo Staphylococcus aureus (1,4 -7) .…”

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Nursing actions to prevent infection of central venous catheters: an integrative review

Oliveira

Guilherme²,

Taets³

et al. 2017

ijcrr

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Resumo:O objetivo do estudo foi demonstrar qual a conduta preventiva de maior impacto para a redução dos riscos de infecção do cateter venoso central (CVC). Metodologia: Trata-se de uma revisão integrativa, entre 2009 a 2014, nas bases de dados LILACS, MEDLINE e SciELO. Após a seleção do material, procedeu-se à leitura sistemática das referências buscando analisá-las de acordo com o tema em questão, foram selecionados 10 artigos. Resultados: As infecções da corrente sanguínea configuram uma complicação frequente, em que os CVC de curta permanência, são as principais causas destas infecções. A frequência de troca do curativo foi o mais encontrado pelo estudo. Conclusão: as condutas preventivas de maior impacto para a redução dos riscos de infecção do cateter venoso central são a implementação de programas de treinamento, educação contínua e a utilização de blundles. Descritores: cuidados de enfermagem, infecção hospitalar, infecções relacionadas a cateter. Nursing actions to prevent infection of central venous catheters: an integrative review Abstract:The aim of the study was to demonstrate the most important preventive approach to reduce the risks of central venous catheter (CVC) infection. Methodology: This is an integrative review, between 2009 and 2014, in the LILACS, MEDLINE and SciELO databases. After the selection of the material, a systematic reading of the references was made, analyzing them according to the theme in question, 10 articles were selected. Results: Bloodstream infections are a frequent complication, in which short-term CVCs are the main causes of these infections. The frequency of dressing replacement was the most commonly found in the study. Conclusion: the preventive measures that have the greatest impact in reducing the risks of central venous catheter infection are the implementation of training programs, continuing education and the use of blundles.

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Microrganismos isolados de pacientes em hemodiálise por cateter venoso central e evolução clínica relacionada

Cited by 15 publications

References 9 publications

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case–control study

Nursing actions to prevent infection of central venous catheters: an integrative review

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