Surveillance of Hemodialysis-Associated Primary Bloodstream Infections: The Experience of Ten Hospital-Based Centers

Dopirak, Margaret; Hill, Connie; Oleksiw, Marylee; Dumigan, Diane G.; Arvai, Jean; English, Ellen; Carusillo, Evelyn; Malo-Schlegel, Susan; Richo, Jeana; Traficanti, Karen; Welch, Bobbie; Cooper, Brian

doi:10.1086/502000

Cited by 68 publications

(54 citation statements)

References 8 publications

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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: 74%

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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Section: Discussionsupporting

confidence: 74%

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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“…In a second surveillance study, Dopirak et al 5 determined rates of BSI among patients at 10 dialysis centers in Connecticut during 1999 to 2000. The Centers for Disease Control and Prevention (CDC) definition for primary BSI was used.…”

Section: Jerome I Tokars Md Mphmentioning

confidence: 99%

“…In studies of hemodialysis patients, BSI rates have been expressed as infections per 1,000 patient-days, 1,000 dialysis sessions 3 3 Dopirak et al 5 Stevenson et al 7 Tokars et al 8 Price et al 4 erally have 3 hemodialysis sessions per week), 100 patientmonths, 4 ' 8 or 100 patient-years 4 ; all express the same concept, and rates are easily converted from one denominator to another. In the CDC surveillance system, the number of patients at risk is determined only once a month.…”

Section: Jerome I Tokars Md Mphmentioning

confidence: 99%

Bloodstream Infections in Hemodialysis Patients: Getting Some Deserved Attention

Tokars

2002

Infect. Control Hosp. Epidemiol.

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“…Unfortunately, few dosing schemes have been developed for patients receiving high-flux hemodialysis (HFHD). Furthermore, bloodstream infections are common in hemodialysis patients, with Gram-negative bacilli accounting for 14 to 43% of these events (3)(4)(5)(6). With few new drugs for Gram-negative bacilli on the horizon, optimization of potent drugs with activity against Gramnegative organisms, such as ceftazidime, is now more important than ever.…”

mentioning

confidence: 99%

Pharmacodynamic Target Attainment for Various Ceftazidime Dosing Schemes in High-Flux Hemodialysis

Loo

Neely

Anderson

et al. 2013

Antimicrob Agents Chemother

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f Ceftazidime is a broad-spectrum cephalosporin with high-level activity against a variety of Gram-negative pathogens, including Pseudomonas aeruginosa. Improved outcomes are associated with cumulative percentages of a 24-h period that the drug concentration exceeds the MIC under steady-state pharmacokinetic conditions (%T MIC ) of >45 to 70% of the dosing interval. Optimal dosing to achieve a 90% probability of target attainment (PTA) in patients receiving high-flux hemodialysis (HFHD) is unknown. We used existing data from six anephric adults receiving hemodialysis to construct a population model with the Pmetrics package for R. From the final model's joint probability density, we simulated the PTA for various ceftazidime dosing regimens, HFHD schedules, and organism MICs. For HFHD every 48 h and 1 g of ceftazidime given posthemodialysis, the PTA exceeds 90% for all isolates with MICs of <8 g/ml, assuming a goal of 70%T MIC . For 72-h dialysis intervals, postdialysis dosing of 1 g is adequate for achievement of the 70%T MIC goal only for organisms with MICs of <4 g/ml, while 2 g is adequate for organisms with MICs of <8 g/ml. A dose of 500 mg once daily, regardless of HFHD schedule, has a 90% PTA for organisms with MICs of <16 g/ml, while 1 g once daily may achieve 100% PTA even for resistant organisms with a MIC of 32 g/ml. Therefore, to ensure maximal ceftazidime activity, once-daily dosing of 500 mg to 1 g ceftazidime in patients receiving HFHD may be preferable for critically ill patients when MIC data are unavailable and for more resistant organisms with ceftazidime MICs of 16 to 32 g/ml.

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Surveillance of Hemodialysis-Associated Primary Bloodstream Infections: The Experience of Ten Hospital-Based Centers

Cited by 68 publications

References 8 publications

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

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

Bloodstream Infections in Hemodialysis Patients: Getting Some Deserved Attention

Pharmacodynamic Target Attainment for Various Ceftazidime Dosing Schemes in High-Flux Hemodialysis

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