Int J Med Sci 2013; 10(12):1632-1638. doi:10.7150/ijms.6710
Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis
1. Department of Internal Medicine-Infectious Disease Unit University Hospital of Heraklion, Crete, Greece
2. Department of Nephrology, University Hospital of Heraklion, Crete, Greece
3. Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
4. Department of Medicine, Henry Dunant Hospital, Athens, Greece
5. Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
6. Department of Medicine, Hygeia Hospital, Marousi, Athens, Greece
7. Hellenic Center for Disease Control and Prevention, Marousi, Athens, Greece
Fysaraki M, Samonis G, Valachis A, Daphnis E, Karageorgopoulos DE, Falagas ME, Stylianou K, Kofteridis DP. Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis. Int J Med Sci 2013; 10(12):1632-1638. doi:10.7150/ijms.6710. Available from http://www.medsci.org/v10p1632.htm
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.
Keywords: Antimicrobial Resistance, Sepsis, Vascular Catheter-Related Infections, Epidemiology