Organism-specific bacteremia by hemodialysis access

Zhang, Jingjing; Burr, Renee; Sheth, Heena; Piraino, Beth

doi:10.5414/cn108633

Cited by 21 publications

(15 citation statements)

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“…These rates are similar to a Japanese Society for Peritoneal Dialysis report covering 3042 patients, and 114 centers over 31,686 patient months that reported a rate of 0.195 episodes per years, with a very low rate of Staphylococcus epidermidis of 0.01 episodes per year at risk (31). In reality, patients who start dialysis using a hemodialysis catheter are at high risk for positive blood cultures, many fold higher than performing dialysis using an arteriovenous fistula (32). This is probably in part why mortality is higher in those starting dialysis with a hemodialysis catheter than those starting dialysis with a PD catheter or with an arteriovenous fistula or graft (33).…”

Section: Risk Of Peritonitissupporting

confidence: 79%

Innovations in Treatment Delivery, Risk of Peritonitis, and Patient Retention on Peritoneal Dialysis

Piraino

2017

Seminars in Dialysis

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Early innovations in the delivery of peritoneal dialysis (PD) markedly improved its acceptability and lowered peritonitis rates. The standard osmotic agent was, and continues to be dextrose, an agent that is not ideal as it is readily absorbed. The development of icodextrin-containing dialysis fluid has allowed a long dwell time to provide more effective ultrafiltration. The development of a smaller, more easily used automated cycler, led to an increase in the proportion of patients on the cycler as opposed to CAPD. Recently, new cyclers with better teaching tools and ease of use and communication with the training team have come on the market; data on outcomes using these cyclers are not yet available. Peritonitis continues to be a serious complication of PD although improvements in connectology and research on Staphylococcus aureus carriage have decreased peritonitis risk. Peritonitis rates continue to vary tremendously from one program to another, which may be in part due to failure to follow best demonstrated practices in training, care of the l catheter exit site, and prevention of peritonitis. Peritonitis rates should be expressed as episodes per year at risk and as organism-specific rates to allow comparisons from one program to another, from one period to another and from a program to the published literature. The term technique failure is misused in PD. Patients leave PD for a host of reasons including transplantation. Transfer from PD to hemodialysis can be planned and have an excellent outcome or can be delayed or done emergently and have a less optimal outcome. The life plan of the patient with ESRD needs to be not only considered but also periodically revised as circumstances and patient wishes change.

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Section: Risk Of Peritonitissupporting

confidence: 79%

Innovations in Treatment Delivery, Risk of Peritonitis, and Patient Retention on Peritoneal Dialysis

Piraino

2017

Seminars in Dialysis

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“…However, the rate is still higher than in general population. 29 , 33 Patients with MRSA bacteremia had higher mortality compared with those with MSSA bacteremia. 34 Despite the use of appropriate antibiotic, a significantly high mortality was found in the MRSA compared with MSSA infections.…”

Section: Discussionmentioning

confidence: 99%

Chronic dialysis patients with infectious spondylodiscitis have poorer outcomes than non-dialysis populations

Kuo¹,

Sun²,

Lu³

et al. 2018

TCRM

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PurposeInfectious spondylodiscitis is a serious disease that can lead to permanent neurological deficit. Because there were only a few case reports or series featuring infectious spondylodiscitis in chronic dialysis patients, we investigated the epidemiology and outcome in the chronic dialysis patients versus general population.Materials and methodsWe retrospectively identified chronic dialysis patients admitted for infectious spondylodiscitis between January 2002 and December 2015. A total of 105 chronic dialysis patients were included, and we performed a 1:2 case–control match on propensity score in non-dialysis patients with infectious spondylodiscitis. The demographic features, clinical manifestation, infection focus, and disease outcome were recorded.ResultsA total of 302 patients entered the final analysis. Chronic dialysis patients less frequently had fever (34.3%), and in the majority, bacterial entry was through dialysis vascular access (30.5%). Methicillin-resistant Staphylococcus aureus (MRSA) comprised the majority of causative pathogen. The chronic dialysis group had longer hospital stay, higher in-hospital mortality, and higher 1-year mortality. The odds ratio of in-hospital mortality was 2.20 compared with the non-dialysis group.ConclusionsThe study highlighted poorer outcome and high frequency of resistant Staphylococcus of infectious spondylodiscitis in chronic dialysis patients. Therefore, high vigilance, prompt recognition, and empiric coverage of MRSA will be important in the management of infectious spondylodiscitis in chronic dialysis patients.

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“…Hemodialysis catheter uses were at higher risk of bacteremia compared with arteriovenous fistula or graft uses. A single center study in the United States indicated that the rate of positive blood cultures in patients with central venous catheters was 1.86/1000 d and 0.08/1000 d in patients with an arteriovenous fistula and 0.31/1000 d in patients with an arteriovenous graft[30]. Rate of infection related hospitalization was higher in the patients with catheters or arteriovenous grafts compared with arteriovenous fistula, the rate ratios were 1.59 and 1.37, respectively[5].…”

Section: Risk Factorsmentioning

confidence: 99%

Bacteremia in hemodialysis patients

Suzuki

Satoh

Nakamura

et al. 2016

WJN

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Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection (CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients.

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Organism-specific bacteremia by hemodialysis access

Cited by 21 publications

References 0 publications

Innovations in Treatment Delivery, Risk of Peritonitis, and Patient Retention on Peritoneal Dialysis

Innovations in Treatment Delivery, Risk of Peritonitis, and Patient Retention on Peritoneal Dialysis

Chronic dialysis patients with infectious spondylodiscitis have poorer outcomes than non-dialysis populations

Bacteremia in hemodialysis patients

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