Risk Factor Analysis for Long-Term Tunneled Dialysis Catheter-Related Bacteremias

Abstract

Infection, mainly related to vascular access, is one of the main causes of morbidity and a preventable cause of death in hemodialysis patients. From January 1994 to April 1998 we conducted a prospective study to assess the incidence and risk factors of catheter-related bacteremia. One hundred and twenty-nine tunneled dual-lumen hemodialysis catheters were inserted percutaneously into the internal jugular vein in 89 patients. Bacteremia (n = 56) occurred at least once with 37 (29%) of the catheters (an incidence of 1.1/1,000 catheter-days); local infection (n = 45, 1/1,000 catheter-days) was associated with bacteremia in 18 cases. Death in 1 case was directly related to Staphylococcus aureus (SA) septic shock, and septicemia contributed to deaths in 2 additional cases. Catheters were removed in 48% of the bacteremic episodes. Treatment comprised intravenous double antimicrobial therapy for 15–20 days. Bacteriological data of bacteremia showed 55% involvement of SA. Nasal carriage of SA was observed in 35% of the patients with catheters. Bacteremic catheters were more frequently observed in patients with diabetes mellitus (p = 0.03), peripheral atherosclerosis (p = 0.001), a previous history of bacteremia (p = 0.05), nasal carriage of SA (p = 0.0001), longer catheter survival time (p = 0.001), higher total intravenous iron dose (p = 0.001), more frequent urokinase catheter infusion (p < 0.01), and local infection (p < 0.001) compared with non-bacteremic catheters. Monovariate survival analysis showed that significant initial risk factors for bacteremia were nasal carriage of SA (p = 0.00001), previous bacteremia (p = 0.0001), peripheral atherosclerosis (p = 0.005), and diabetes (p = 0.04). This study confirms the relatively high incidence of bacteremia with tunneled double-lumen silicone catheters and its potential complications. Possible preventive actions are discussed according to the risk factors.

Modulation of Iron Metabolism and Hepcidin Release by HFE Mutations in Chronic Hemodialysis Patients: Pathophysiological and Therapeutic Implications

“…An updated mortality curve for cardiovascular disease and infection in 127 Italian CHD patients subdivided according to the presence or not of the C282Y and H63D HFE mutations is shown in figure 1. It is worthy of note that, in patients negative for HFE mutations, we observed a higher mortality due to sepsis, previously associated with a higher iron dosage (Jean, Charra et al 2002;Teehan, Bahdouch et al 2004), and due to cardiovascular disease, possibly linked to hypertension and thromboembolic events related to ESAs (Miyashita, Tojo et al 2004;Phrommintikul, Haas et al 2007) and oxidative stress related to iron (Valenti, Valenti et al 2007). Fig.…”

“…As mentioned above, although treatment with ESAs and IV iron formulations (Locatelli, Aljama et al 2004) are generally prescribed, functional iron deficiency is a common finding, determining the need for high doses of ESAs and iron, both associated with adverse events. Indeed, high ESAs doses have been associated with mortality due to cardiovascular events related to hypertension and hypercoagulability (Miyashita, Tojo et al 2004;Phrommintikul, Haas et al 2007;Strippoli, Tognoni et al 2007), whereas excess iron promotes vascular damage by inducing oxidative stress, and heightens the risk of infections (Seifert, von Herrath et al 1987;Jean, Charra et al 2002;Teehan, Bahdouch et al 2004;Kalantar-Zadeh, Regidor et al 2005;Valenti, Valenti et al 2007). The mechanism proposed to explain refractoriness to IV iron was previously related to the inhibition of erythropoiesis and iron recycling from macrophages by inflammation (Stenvinkel 2003).…”

A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China

“…Additionally, a significantly larger proportion of patients in the symmetrical-tip catheter group had metabolic disorders compared with the step-tip catheter group, which may have affected the study outcomes. However, although some research suggests that diabetes is associated with an increased risk of catheter-related infection, 26 there are counter examples reporting that diabetes is not a significant independent risk factor for catheter-related infection. 15,27,28 Despite these limitations, our findings provide a valuable contribution to the existing literature supporting the use of symmetrical-tip catheters for chronic hemodialysis, and provide the first report of symmetrical-tip catheter use in China.…”

HFE Mutations Modulate the Effect of Iron on Serum Hepcidin-25 in Chronic Hemodialysis Patients

“…Functional iron deficiency is a common finding, determining the need for high doses of ESAs and iron, both associated with adverse events. High doses of ESAs increase the risk of mortality due to cardiovascular events related to hypertension and hypercoagulability (9 -11), whereas excess iron promotes vascular damage by inducing oxidative stress and heightens the risk of infections (12)(13)(14)(15)(16). The mechanism proposed to explain refractoriness to i.v.…”