Prospective study of microbial colonization of the nose and skin and infection of the vascular access site in hemodialysis patients

Kaplowitz, Lisa G.; Comstock, J A; Landwehr, Douglas M.; Dalton, Harry P.; Mayhall, C. Glen

doi:10.1128/jcm.26.7.1257-1262.1988

Cited by 77 publications

(24 citation statements)

References 13 publications

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“…39 Patients must be more careful about their hygiene because it seems to be the most important modifiable risk factor. 40 The critical issues in the management of AV graft infection are the need to eradicate infection and to achieve HD with reduced morbidity. Treatment involves intravenous antibiotics and total graft excision in septic patients or when the graft is bathed in pus; subtotal, when all of the graft is removed except an oversewn small cuff of prosthetic…”

Section: Avg Complicationsmentioning

confidence: 99%

Vascular access for hemodialysis: current perspectives

Santoro¹,

Benedetto²,

Mondello³

et al. 2014

IJNRD

276

257

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A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC). AVF, described by Brescia and Cimino, remains the first choice for chronic HD. It is the best access for longevity and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries. Once autogenous options have been exhausted, prosthetic fistulae become the second option of maintenance HD access alternatives. CVCs have become an important adjunct in maintaining patients on HD. The preferable locations for insertion are the internal jugular and femoral veins. The subclavian vein is considered the third choice because of the high risk of thrombosis. Complications associated with CVC insertion range from 5% to 19%. Since an increasing number of patients have implanted pacemakers and defibrillators, usually inserted via the subclavian vein and superior vena cava into the right heart, a careful assessment of risk and benefits should be taken. Infection is responsible for the removal of about 30%–60% of HD CVCs, and hospitalization rates are higher among patients with CVCs than among AVF ones. Proper VA maintenance requires integration of different professionals to create a VA team. This team should include a nephrologist, radiologist, vascular surgeon, infectious disease consultant, and members of the dialysis staff. They should provide their experience in order to give the best options to uremic patients and the best care for their VA.

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Section: Avg Complicationsmentioning

confidence: 99%

Vascular access for hemodialysis: current perspectives

Santoro¹,

Benedetto²,

Mondello³

et al. 2014

IJNRD

276

257

View full text Add to dashboard Cite

show abstract

“…Staphylococcal translocation from colonized nasal mucosa to the bloodstream has been considered as the potential source of bacterial invasion in HD patients because of their immunodeficiency and the process of HD, which requires vascular access for prolonged periods . Effectively, several studies evaluated the importance of nasal carriage for the development of S. aureus infections in HD patients . The severity of these infections is associated with multiple toxins produced by this bacterium, such as the staphylococcal enterotoxins and the related toxic shock syndrome toxin‐1 (TSST‐1).…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus aureus nasal carriage in a Moroccan dialysis center and isolates characterization

Oumokhtar

Elazhari

Timinouni

et al. 2012

Hemodialysis International

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Staphylococcus aureus, which has its ecological niche in the anterior nares, has been shown to cause a variety of infectious diseases mainly for patients in hemodialysis units. We performed this study to evaluate the prevalence of nasal S. aureus carriage among hemodialysis outpatients, to determine the antimicrobial susceptibility of isolates, to characterize the virulence genes, and to identify associated risk factors. Nares swab specimens were obtained from 70 outpatients on hemodialysis between March and June 2010. Samples were plated immediately onto S. aureus specific media and pattern of antibacterial sensitivity was determined using disk diffusion method. Polymerase chain reaction was used to detect nuc, mecA, and genes encoding staphylococcal toxins. Medical record of patients was explored to determine S.aureus carriage risk factors. Nasal screening identified 42.9% S. aureus carriers with only one (3.3%) methicillin-resistant S. aureus isolate. Among the methicillin-susceptible S. aureus isolates, high rate of penicillin resistance (81.8%) has been detected. The identified risk factors were male gender and age ≤ 30 years. Research of virulence factors showed a high genetic diversity among the 30 S. aureus isolates. Twenty-one (70%) of them had at least one virulence gene, of which 3.3% were Panton-Valentine leukocidin (lukS/F-PV) genes. S. aureus carriage must be screened for at regular intervals in hemodialysis patients. Setting up a bacterial surveillance system is one of the strategies to understand the epidemiology of methicillin-resistant S. aureus, to guide local antibiotic policy and prevent spread of antibiotic-resistant S. aureus.

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“…1,2 The pathogen accounts for 70% to 96% of all vascular access infections. 3 Thus, effective prophylaxis of vascular access infection and bacteremia is a worthwhile goal in the management of hemodialysis population.…”

Section: Introductionmentioning

confidence: 99%

Carriage of Staphylococcus aureus in the nose of patients on regular dialysis treatment using hemodialysis catheters

Maamoun

Soliman

Sherif

2011

Hemodialysis International

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In the hemodialysis population, the incidence of Staphylococcus aureus colonization has been documented to be as high as 80%; effective prophylaxis of vascular access infection and bacteremia is a worthwhile goal in the management of hemodialysis population. Surveillance of 50 hemodialysis patients for S. aureus-positive nasal cultures was performed by monthly nasal swabs over a 12-month period. All patients were performing dialysis using hemodialysis catheters thrice weekly. All positive cultures were treated with a prophylactic antibiotic regimen. Thirty-one patients (62%) had one or more positive cultures. The surveillance period was longer in the S. aureus nasal carriers (p < 0.01). The frequency of positive cultures correlated with the duration of surveillance (p < 0.05). The incidence of S. aureus bacteremia was greater in patients with three or more positive cultures (p < 0.05). This study suggests that continuous surveillance for S. aureus nasal colonization is essential to properly identify all hemodialysis patients using catheters at risk of developing S. aureus bacteremias.

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Prospective study of microbial colonization of the nose and skin and infection of the vascular access site in hemodialysis patients

Cited by 77 publications

References 13 publications

Vascular access for hemodialysis: current perspectives

Vascular access for hemodialysis: current perspectives

Staphylococcus aureus nasal carriage in a Moroccan dialysis center and isolates characterization

Carriage of Staphylococcus aureus in the nose of patients on regular dialysis treatment using hemodialysis catheters

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