Rate of bacteremia in the hemodialysis patient presenting to the emergency department with fever: a retrospective chart review

Abstract

BackgroundInfectious disease is the second most common cause of death in patients receiving hemodialysis (HD). When presenting to the emergency department (ED) with fever, it remains a diagnostic challenge to distinguish patients with potentially life-threatening bacterial infections from those with less significant causes of fever. The primary goal of this study was to determine the rate of bacteremia in HD patients presenting to the ED with fever. The secondary goal of this study was to identify any independent risk factors associated with bacteremia in the febrile HD patient.MethodsThis is a retrospective medical record review of all HD patients who presented to the ED with either subjective fever as primary complaint or with a documented triage temperature of 38 °C or higher during the 3-year period between September 1, 2014, and September 1, 2017. Patient visits were included in the study if blood cultures were ordered in the ED. Data related to demographic information, clinical parameters, diagnostic test results in the ER, final diagnosis, and results of microbiology cultures were collected from each patient encounter. Univariate analysis was performed to identify risk factors associated with bacteremia.ResultsWe identified 353 patient visits from 138 unique patients that met inclusion criteria. Fifty-eight percent of these were women, and the average age was 54.6 years. The rate of bacteremia was 31.7%, and the main microorganisms isolated in blood culture were non-MRSA Staphylococcus aureus (40.7%), MRSA (13.3%), Pseudomonas aeruginosa (11.5%), and Enterobacter spp. (11.5%). Independent prognostic factors associated with bacteremia were use of dialysis catheter, prior history of bacteremia, and > 5% neutrophilic band cells (OR 6.55 [95% CI 3.96–10.8; p < 0.0001]; OR 8.87 [95% CI 5.32–14.8; p < 0.0001]; OR 3.32 [95% CI 1.90–5.80; p < 0.0001] respectively).ConclusionHD patients presenting to the ED with fever have high rates of bacteremia, with a significantly higher rate in patients using dialysis catheters or those with a history of bacteremia. Other clinical data available in the ED is minimally useful in predicting bacteremia.

A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear)

“…Vancomycin is an antibiotic widely used in HD units because of the high rate of infections, many of which are related to vascular access, frequently caused by gram-positive organisms. Vancomycin is the empiric treatment of choice for these patients [14,15]. This study assessed the clearance of vancomycin on MCO-HD compared to high-flux HD.…”

The effects of bacterial endotoxin LPS on synaptic transmission at the neuromuscular junction

“…Both P. a. and S. m. are known to play a role in septicaemia in humans and other mammals [27, 28, 29, 30] but the direct action of LPS, from these bacterial strains, on neural tissue has not been fully investigated. It is known that LPS from S. m. is more potent than from P. a. in inducing an immune response in mammals [31, 32, 33].…”

Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013–2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations

“…In Europe, there are only a few population-based surveillance systems [5, 6]. Community-onset bacteraemia is a common problem in patients visiting emergency departments (EDs) [7, 8], and bacteraemia is associated with significant healthcare costs and mortality. The bacteraemia-associated mortality rate has been shown to decrease with early administration of appropriate antimicrobial therapy [9–13].…”