BACKGROUND: Bloodstream infections (BSI) are a major complication of hemodialysis. The risk of infection among hemodialysis patients is usually associated with the dialysis procedure itself, specifically the means of vascular access.OBJECTIVES: Estimate the rate of BSI and assess factors possibly associated with BSI.DESIGN: Analytical retrospective medical record review.SETTING: Hemodialysis unit in a tertiary care center.PATIENTS AND METHODS: Adult patients (18–60 years old) who had hemodialysis as first renal replacement therapy in the 20-month period from January 2014 to August 2016 were included in this study. Demographic and clinical characteristics were used in a multivariate logistic regression to assess factors that might be associated with BSI.MAIN OUTCOME MEASURES: The rate of BSI and associated factors among chronic hemodialysis outpatients.SAMPLE SIZE AND CHARACTERISTICS: 160 outpatients on hemodialysis, median (IQR) age 47.7 (37.0–56.0) years, males (60.6%).RESULTS: The rate of BSI was 0.4 per 100 patient-months. Multivariate logistic regression revealed that patients who had central venous catheters had the highest risk for BSI (odds ratio: 10.088; 95% CI= 2.595–39.215; P=.001) compared with arteriovenous fistulas. Gram-negative bacteria were isolated in 54.6% of cases, with coagulase-negative Staphylococcus the most frequent isolate (18.2%), followed by Klebsiella pneumoniae and Enterobacteriaceae (15.2%, each).CONCLUSIONS: The type of vascular access type is the main risk factor associated with BSI in hemodialysis patients. The arteriovenous fistula, which has a lower infection rate compared to the catheter, is the best available option for hemodialysis patients.LIMITATIONS: Retrospective, single center and relatively small sample size.CONFLICT OF INTEREST: None.

Purpose The purpose of this study is to investigate the effect of montelukast on lipopolysaccharide (LPS)-induced pancreatitis. Methods Acute pancreatitis was induced by a single dose of LPS (6 mg/kg, i.p.) while montelukast was given in two different doses (10 and 20 mg/kg/day) for three consecutive days prior to injection of LPS. Results Acute pancreatitis was demonstrated by significant increases in serum levels of pancreatic enzymes lipase and amylase and lactate dehydrogenase (LDH). Proinflammatory response activation was evident by elevated serum levels of nitric oxide (NO) and increased pancreatic concentrations of tumor necrosis factor- α (TNF-α), interleukin-1 (IL-1β) and intercellular adhesion molecule-1 (ICAM-1). The activity of myeloperoxidase (MPO), a neutrophil infiltration marker, has also been increased. Oxidative stress was confirmed by significant increases in the concentrations of lipid peroxides measured as thiobarbituric acid reactive substances (TBARS) and decreases in the concentrations of reduced glutathione (GSH) in the pancreatic tissues of animals treated with LPS. Histological examination confirmed the biochemical alterations. Montelukast treatment reversed all these biochemical indices and histopathological changes that were induced by LPS. Montelukast reduced the increase in serum levels of lipase, amylase, LDH, total nitrite/nitrate, TNF-α, IL-1β and ICAM-1. MPO activities and TBARS concentrations were also suppressed while GSH content was increased in pancreatic tissues. Conclusion These results show that montelukast may be a useful pharmacological agent in protection against LPS-induced oxidative pancreatic injury by inhibiting neutrophil infiltration, counteracting oxidative stress, and suppressing inflammatory mediators.

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