<i>Special Report</i>: Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)—Data Summary for 2006

Klevens, R. Monina; Edwards, Jonathan R.; Andrus, Mary; Peterson, Kelly; Dudeck, Margaret A.; Horan, Teresa C.

doi:10.1111/j.1525-139x.2007.00379.x

Cited by 150 publications

(147 citation statements)

References 11 publications

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“…The high prevalence of both risk factors at baseline underscore their importance for patients with ESRD (20,21). This study is also consistent with previous studies showing that patients with synthetic or heterologous tissue grafts are at higher risk of S. aureus infection than patients with arteriovenous fistulas (22). Hospitalizations for S. aureus bloodstream or non-bloodstream infections in patients undergoing hemodialysis impose considerable economic costs on the health care system.…”

Section: Discussionsupporting

confidence: 81%

Outcomes of Staphylococcus aureus Infection in Hemodialysis-Dependent Patients

Friedman

O’Neal

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Staphylococcus aureus is a leading cause of infection in patients with ESRD. Clinical and economic outcomes associated with S. aureus bacteremia and other S. aureus infections in patients with ESRD were examined.Design, setting, participants, & measurements: Laboratory, clinical, and hospital billing data from a randomized trial of 3359 hemodialysis-dependent patients hospitalized with S. aureus infection in the United States whose vascular access type was fistula or graft and who were hospitalized with S. aureus infection to evaluate inpatient costs, hospital days, and mortality over 12 wk were used. Generalized linear regression was used to identify independent predictors of 12-wk costs, inpatient days, and mortality.Results: Of the 279 patients (8.3%) who developed S. aureus infection during approximately 1 yr of follow-up, 25.4% were treated as outpatients. Among patients for whom billing data were available, 89 patients hospitalized with S. aureus bacteremia incurred mean 12-wk inpatient costs of $19,454 and 11.9 inpatient days. Among the 70 patients hospitalized with non-bloodstream S. aureus infections, mean inpatient costs were $19,222 and the mean number of inpatient days was 11.3. Twelve-week mortality was 20.2 and 15.7% for patients with S. aureus bloodstream and non-bloodstream infections, respectively. Older age was independently associated with higher risk of death among patients with S. aureus bacteremia and with higher inpatient costs and more hospital days among patients with non-bloodstream infections.Conclusions: Hemodialysis-dependent patients with fistula or graft access incur high costs and long inpatient stays when hospitalized for S. aureus infection.

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Section: Discussionsupporting

confidence: 81%

Outcomes of Staphylococcus aureus Infection in Hemodialysis-Dependent Patients

Friedman

O’Neal

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…There is general consensus that use of catheters as opposed to permanent arteriovenous fistulae or grafts contributes to excessive mortality not only during this period but throughout a patient's course on hemodialysis. The rate of catheter-related bloodstream infection (CRBSI) reported in the literature varies, with rates from 2.5 to 6.6 per 1000 catheter days reported (3)(4)(5)(6)(7). The Centers for Disease Control and Prevention (CDC) reports that CRBSI rates have remained steady in hemodialysis patients over the last decade, with an estimated 37,000 CRBSIs occurring in 2008 (8).…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

Moore

Besarab

Ajluni

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Infection is the second leading cause of death in hemodialysis patients. Catheterrelated bloodstream infection and infection-related mortality have not improved in this population over the past two decades. This study evaluated the impact of a prophylactic antibiotic lock solution on the incidence of catheter-related bloodstream infection and mortality.Design, setting, participants, & measurements This prospective, multicenter, observational cohort study compared the effectiveness of two catheter locking solutions (gentamicin/citrate versus heparin) in 555 hemodialysis patients dialyzing with a tunneled cuffed catheter between 2008 and 2011. The groups were not mutually exclusive. Rates of catheter-related bloodstream infection and mortality hazards were compared between groups.Results The study population (n=555 and 1350 catheters) had a median age of 62 years (interquartile range=41-83 years), with 50% men and 71% black. There were 427 patients evaluable in the heparin period (84,326 days) and 322 patients evaluable in the antibiotic lock period (71,192 days). Catheter-related bloodstream infection in the antibiotic lock period (0.45/1000 catheter days) was 73% lower than the heparin period (1.68/1000 catheter days; P=0.001). Antibiotic lock use was associated with a decreased risk of catheter-related bloodstream infection compared with heparin (risk ratio, 0.23; 95% confidence interval, 0.13 to 0.38 after multivariate adjustment). Cox proportional hazards modeling found that antibiotic lock was associated with a reduction in mortality (hazard ratio, 0.36; 95% confidence interval, 0.22 to 0.58 in unadjusted analyses; hazard ratio, 0.32; 95% confidence interval, 0.14 to 0.75 after multivariate adjustment). The rate of gentamicin-resistant organisms decreased (0.40/1000 person-years to 0.22/1000 person-years) in the antibiotic lock period (P=0.01). ConclusionsThe results of this study show that the use of a prophylactic, gentamicin/citrate lock was associated with a substantial reduction in catheter-related bloodstream infection and is the first to report a survival advantage of antibiotic lock in a population at high risk of infection-related morbidity and mortality.

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“…one of the most frequent causes of sepsis in patients under hemodialysis, and the incidence rates range from 0.5 to 7.6 episodes per 1000 catheterdays [1][2][3][4][5].…”

Section: Hemodialysis Catheter-related Bloodstream Infection (Hc-rbsimentioning

confidence: 99%

Endocarditis with Permanent Hemodialysis Tunneled Catheter: A Severe and Multidisciplinary Situation

Maaoui¹,

M²,

Gaied³

et al. 2017

Int J Neurorehabilitation Eng

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Tunnelled catheter endocarditis is a frequent and sever situation among hemodialysis patients. The management should be fast and multidisciplinary.Case report: We report the case of a 36 year old woman with a history of systemic erythematous lupus, discovered at the age of twenty. She profited from a tunneled catheter because of exhaustion of her venous capital. One year later, the patient had an endocarditis of the tricuspid valve. An echocardiogram demonstrated mobile and friable 8 mm vegetation in the tricuspid valve. Blood cultures were positive for pseudomonas and klebsiella. The catheter was removed at the fifth day of the infection. The patient received antibiotic treatment which was changed on several occasions in front of multiresistant strains. Ten days later, the blood culture showed Candida albicans. The echocardiogram demonstrated an increase of the size of the vegetation to 15 mm. A chest CT carried out in front of a respiratory distress showed pulmonary septic emboli. Tricuspid valve replacement was performed. Culture of native valve was positive for multiresistant candida famata. The patient developed a pulmonary embolism causing her death.Discussion: Endocarditis with permanent catheter is a severe situation with high mortality and poor prognosis among hemodialysis patients. Immune suppression due to a renal failure and auto immune disease can support the development of multiresistant strains difficult to treat. Conclusion:Endocarditis on tunneled catheter is a serious infection. Nephrologists, cardiologists and infectiologists must collaborate in order to provide adequate therapy.

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Special Report: Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)—Data Summary for 2006

Cited by 150 publications

References 11 publications

Outcomes of Staphylococcus aureus Infection in Hemodialysis-Dependent Patients

Outcomes of Staphylococcus aureus Infection in Hemodialysis-Dependent Patients

Comparative Effectiveness of Two Catheter Locking Solutions to Reduce Catheter-Related Bloodstream Infection in Hemodialysis Patients

Endocarditis with Permanent Hemodialysis Tunneled Catheter: A Severe and Multidisciplinary Situation

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