Retrospective Analysis of Catheter-Related Infections in a Hemodialysis Unit

Colville, Linda; Lee, Andy H.

doi:10.1086/507821

Cited by 20 publications

(15 citation statements)

References 9 publications

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“…The majority of the present BSIs were caused by gram positive micro- organisms, while the two most common pathogens isolated were, not surprisingly, the skin-derived Staphylococcus aureus and Staphylococcus epidermis , a finding consistent with other investigators' experience 8,9,14,15,22.…”

Section: Discussionsupporting

confidence: 91%

“…One fourth of the bacteremic episodes were caused by gram-negative pathogens resistant to common antimicrobial agents, a proportion consistent with prior studies 9,10,15,22. It is worth noting that a substantial percentage of the gram-negative isolates (25%) were sensitive only to colistin.…”

Section: Discussionsupporting

confidence: 84%

“…In the present study more than two thirds of the S. aureus and S. epidermidis isolates were methicillin-resistant. It is of note that the proportion of methicillin-resistant pathogens in our study is remarkably higher compared to other studies, suggesting that the use of vancomycin as first-line therapy may be necessary in our unit with regard to local patterns of resistance 9,10,15. However, no vancomycin resistant staphylococci or enterococci have been isolated from the present series of patients.…”

Section: Discussioncontrasting

confidence: 64%

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Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis

Fysaraki¹,

Samonis²,

Valachis³

et al. 2013

Int. J. Med. Sci.

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Objectives: Infection is a common cause of death among hemodialysis patients. The study investigated incidence, risk factors, clinical features and outcome of bloodstream infections (BSIs) in haemodialysis patients.Methods: The records of haemodialysis patients from 1999 to 2005 were reviewed. Risk factors were investigated by multivariate analysis.Results: There were identified 148 bacteremic episodes, in 102 patients. The BSI rate was 0.52 per 1000 patient-days. Of the 148 episodes, 34 occurred in patients with permanent fistulae (0.18/1000 patient-days); 19 in patients with grafts (0.39/1000 patient-days); 28 in patients with permanent tunneled central catheters (1.03/1000 patient-days); and 67 in those with temporary-catheter (3.18/1000 patient-days). With fistula as reference, the BSI ratio was 1.84 with arteriovenous graft (P=.029), 4.85 with permanent central venous catheter (P<.001), and 14.88 with temporary catheter (P <.001). Catheter related were 41 episodes (28%). Gram positive organism were responsible for 96 episodes (65%), with S. aureus ( 55%) the most frequent, followed by S. epidermidis (26%) and Gram-negative for 36 (23%), with E. coli (39%) the most frequent. Infection was polymicrobial in 14 (9.5%). Diabetes (p<0.001), low serum albumin (p=0.040) and low hemoglobin (p<0.001) were significant risk factors. During hospitalization 18 patients (18%) died. Septic shock (p<0.001) and polymicrobial infection (p=0.041) were associated with in-hospital mortality.Conclusion: The risk of BSI in patients undergoing hemodialysis is related to the catheter type and vascular access. Septic shock and polymicrobial infection predispose to unfavourable outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 64%

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Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis

Fysaraki¹,

Samonis²,

Valachis³

et al. 2013

Int. J. Med. Sci.

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“…A study 16 that aimed to identify the incidence of infection and evaluate the profi le of microorganisms isolated showed that 35% of bacteremic episodes were caused by gramnegative bacteria, a rate consistent with those reported in other studies [17][18][19] . Other study that use the medical records of 239 patients undergoing hemodialysis at the Department of Nephrology of the University Hospital of Heraklion, Crete, Greece, identify that, 3 out of 8 isolated (37.5%) Enterobacter spp.…”

Section: Discussionsupporting

confidence: 78%

Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects

Menegueti

Betoni

Bellissimo-Rodrigues

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Introduction:Bloodstream infections are the second most common cause of death among patients on hemodialysis. This study aimed to evaluate the incidence of and risk factors associated with central venous catheter-related infections in patients undergoing hemodialysis, and to identify and characterize the type and antimicrobial susceptibility profi les of the primary microorganisms isolated during one year of follow-up. Methods: A prospective cohort study was conducted in 2014 in a hemodialysis referral center. We included 200 outpatients with acute kidney injury who had no permanent venous access. A nurse assessed the patients for signs of infection three times per week during dressing changes. The clinicopathologic characteristics of patients with and without local or systemic infection were compared. Results: Fifty-fi ve episodes of catheter-related infections occurred in 43 (22%) patients; 38 (69%) were bloodstream infections and 17 (31%) were local infections. Thirty-two (75%) patients with infection had femoral vein catheter placement. In total, 6,240 hemodialysis sessions were performed; the rates of primary bloodstream and local infection were 6.1 and 2.7 episodes per 1,000 patients on daily dialysis, respectively. In the univariate analysis, diabetes was signifi cantly associated with the development of infection, while level of education, ethnicity, age, and sex were not. Gram-negative bacteria were primarily isolated from blood culture specimens (55% of samples). Of the Gram-negative isolates, 56% were resistant to the carbapenems. Conclusions: We identifi ed a high incidence of catheter-related infections caused by resistant microorganisms in patients undergoing hemodialysis via central venous catheters.

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“…Several multicenter studies demonstrate a hierarchy of infection risk associated with vascular access type (Table 1) [13,14,[20][21][22][23].…”

Section: Type Of Accessmentioning

confidence: 99%

Vascular Access Infections: Epidemiology, Diagnosis, and Management

Akoh

2011

Curr Infect Dis Rep

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Infection is the most challenging and life-threatening complication of vascular access and causes significant morbidity, loss of access, and mortality. The aims of this review are to determine the magnitude of the infection problem, identify possible factors, and provide an update on the management of vascular access infections. Infections account for approximately 15% to 36% of all deaths in dialysis patients (the second leading cause after cardiovascular events) and for about 20% of admissions. Several studies demonstrate a hierarchy of infection risk from temporary catheter, tunnelled cuffed catheter, arteriovenous grafts, to arteriovenous fistula in decreasing order. Suspicion of infection must be followed by appropriate blood cultures, including possible simultaneous sampling from a peripheral vein and the access. The best way to treat vascular access infection is prevention, bearing in mind the idea "fistula first" and "lines last", with the appropriate use of arteriovenous grafts and newer devices sandwiched in between.

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Retrospective Analysis of Catheter-Related Infections in a Hemodialysis Unit

Abstract: A hierarchy of infection risk associated with vascular access type is evident. Native arteriovenous fistulae should be recommended for all patients receiving chronic hemodialysis, to minimize infection.

Cited by 20 publications

References 9 publications

Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis

Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis

Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects

Vascular Access Infections: Epidemiology, Diagnosis, and Management

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