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

Abstract

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.

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

“…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.…”

Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case–control study

“…Most authors have shown that, among the microorganisms isolated in blood cultures of hemodialysis patients, 28–65% are Gram positive, and Staphylococcus aureus is the most frequent, and ∼ 45% are Gram negative [9–11]. Gram-positive microorganisms, mainly S. aureus , are associated with higher rates of mortality; primarily when resistant to methicillin (methicillin-resistant S. aureus ; MRSA).…”

“…The results of these studies have led to improved preventive measures, which may have caused a decrease in morbidity and mortality in this population. However, few studies [11] have analyzed the risk factors for morbidity and mortality in patients with end-stage renal disease (ESRD) who have already developed this complication.…”

Complications catheter-related infections in patients on hemodialysis (septic infections of patients on hemodialysis)

“…Rezultati sprovedenih studija ukazuju da je većina kateter-vezanih infekcija uzrokovana gram pozitivnim mikroorganizmima, najčešće Staphylococcus aureus i Staphylococcus epidermis, iako zastupljenost varira od 33-72,8% (4,12). Kod tri naša bolesnika hemokulturom su izolovani gram pozitivni mikroorganizmi, kod dva sa spondilodiscitisom i endokarditisom veštačke valvule izolovan je Enteroccocus faecalis, a kod trećeg bolesnika sa endokarditisom nativne valvule Staphyllococus aureus.…”

“…Infekcije katetera uzrokuju značajan morbiditet i porast mortaliteta bolesnika za više od 50% u odnosu na bolesnike sa nativnom AVF (3). Frekvencija kateter-vezanih infekcija se u većini studija kreće između 1,0 i 5,5 epizoda na 1000 kateter dana (4)(5)(6). Metastatske infekcije su prisutne kod 5 do 10% bolesnika u vidu osteomijelitisa, endokarditisa, septičnog artritisa i epiduralnog abscesa (7).…”