Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

Abstract

BackgroundInfection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.MethodsRisk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.ResultsThere were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09).ConclusionsInfection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

“…With regard to the resistance profiles, we found that 33.3% of the Enterobacteriaceae isolated were multidrug-resistant (MDR) and that 20% of the Staphylococcus aureus isolated was methicillin-resistant (MRSA). The prevalence of MDR Enterobacteriaceae found in this study is similar to the 36.4% resistance rate reported by Fram et al [18]. On reviewing the literature, the resistance of S. aureus varied from 2.1 to 38.5% [14,18].…”

“…The prevalence of MDR Enterobacteriaceae found in this study is similar to the 36.4% resistance rate reported by Fram et al [18]. On reviewing the literature, the resistance of S. aureus varied from 2.1 to 38.5% [14,18]. Nevertheless, MRSA has been reported in hemodialysis outpatient facilities, and every effort must be made to reduce the spread of MDROs as they are associated with higher rates of morbidity and mortality [19].…”

Bacteremia in hemodialysis patients

“…It is unclear whether the ratio of resistant bacteria in hemodialysis patients is higher than that in the general population. In a single-center report from Brazil in 2010-2013, 38.5% of S. aureus was MRSA[25], whereas the methicillin resistance percentage was 31.0% in surveillance data from Brazil in 2005-2008[26]. However, a national surveillance report for England indicated that the relative risk of MRSA bacteremia was approximately 100-fold higher for dialysis patients than for the general population and was 8-fold higher for patients using a catheter than for those with an arteriovenous fistula[27].…”

Infection Control Bundles for the Prevention of Hospital Infections

“…Santral kateter ilişkili kan dolaşımı enfeksiyonunun insidansı 1000 kateter gününde 2,9 ile 17 arasında değişmektedir [25,26] . Santral kateter ilişkili kan dolaşımı enfeksiyon insidansını, YBÜ'lerin kapasitesi, iş yükü, hastaların alt hastalıkları, mevcut hastalığın ağırlığı gibi faktörler belirlemektedir [27] . Ancak, yapılan çalışmalarda enfeksiyon kontrol demet uygulamaları ile SKİ-KDE hızının sıfıra indirilebileceği gösterilmiştir [28,29] .…”