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Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study
BACKGROUND: Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary coho...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390569/ https://www.ncbi.nlm.nih.gov/pubmed/30808313 http://dx.doi.org/10.1186/s12882-019-1253-x |
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author | Mohamed, Husham Ali, Alaa Browne, Leonard D. O’Connell, Nuala H. Casserly, Liam Stack, Austin G. Hussein, Wael F. |
author_facet | Mohamed, Husham Ali, Alaa Browne, Leonard D. O’Connell, Nuala H. Casserly, Liam Stack, Austin G. Hussein, Wael F. |
author_sort | Mohamed, Husham |
collection | PubMed |
description | BACKGROUND: Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary cohort of HD patients at a tertiary nephrology centre. METHODS: A retrospective cohort of 235 chronic HD patients was identified from a regional dialysis programme between Jan 2015 and Dec 2016. Data on demographics, primary renal disease, comorbid conditions and dialysis access type were obtained from the Kidney Disease Clinical Patient Management System (KDCPMS). Data on blood cultures were captured from the microbiology laboratory. Poisson regression with robust variance estimates was used to compare infection rates and relative risk of AR-BSI according to the site and type of vascular access. RESULTS: The mean age was 65 (± 15) years, 77% were men, and the median follow up was 19 months (IQR: 10–24 months), accumulating 2030 catheter-months and 1831 fistula-months. Overall rates of AR-BSI were significantly higher for central venous catheter (CVC) compared to arteriovenous fistula (AVF), (2.22, 95% (CI): 1.62–2.97) versus 0.11 (0.01–0.39) per 100 patient-months respectively), with a rate ratio of 20.29 (4.92–83.66), p < 0.0001. This pattern persisted across age, gender and diabetes subgroups. Within the CVC subgroup, presence of a femoral CVC access was associated with significantly higher rates of AR-BSI (adjusted RR 4.93, 95% CI: 2.69–9.01). Older age (75+ versus < 75 years) was not associated with significant differences in rates of AR-BSI in the unadjusted or the adjusted analysis. Coagulase negative Staphylococcus (61%) and Staphylococcus aureus (23%) were the predominant culprits. AR-BSIs resulted in access loss and hospitalisation in 57 and 72% of events respectively, and two patients died with concurrent AR-BSI. CONCLUSIONS: Rates of AR-BSI are substantially higher in CVC than AVF in contemporary HD despite advances in catheter design and anti-infective protocols. This pattern was consistent in all subgroups. The policy of AVF preference over CVC should continue to minimise patient morbidity while at the same time improving anti-infective strategies through better care protocols and infection surveillance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1253-x) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6390569 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-63905692019-03-11 Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study Mohamed, Husham Ali, Alaa Browne, Leonard D. O’Connell, Nuala H. Casserly, Liam Stack, Austin G. Hussein, Wael F. BMC Nephrol Research Article BACKGROUND: Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary cohort of HD patients at a tertiary nephrology centre. METHODS: A retrospective cohort of 235 chronic HD patients was identified from a regional dialysis programme between Jan 2015 and Dec 2016. Data on demographics, primary renal disease, comorbid conditions and dialysis access type were obtained from the Kidney Disease Clinical Patient Management System (KDCPMS). Data on blood cultures were captured from the microbiology laboratory. Poisson regression with robust variance estimates was used to compare infection rates and relative risk of AR-BSI according to the site and type of vascular access. RESULTS: The mean age was 65 (± 15) years, 77% were men, and the median follow up was 19 months (IQR: 10–24 months), accumulating 2030 catheter-months and 1831 fistula-months. Overall rates of AR-BSI were significantly higher for central venous catheter (CVC) compared to arteriovenous fistula (AVF), (2.22, 95% (CI): 1.62–2.97) versus 0.11 (0.01–0.39) per 100 patient-months respectively), with a rate ratio of 20.29 (4.92–83.66), p < 0.0001. This pattern persisted across age, gender and diabetes subgroups. Within the CVC subgroup, presence of a femoral CVC access was associated with significantly higher rates of AR-BSI (adjusted RR 4.93, 95% CI: 2.69–9.01). Older age (75+ versus < 75 years) was not associated with significant differences in rates of AR-BSI in the unadjusted or the adjusted analysis. Coagulase negative Staphylococcus (61%) and Staphylococcus aureus (23%) were the predominant culprits. AR-BSIs resulted in access loss and hospitalisation in 57 and 72% of events respectively, and two patients died with concurrent AR-BSI. CONCLUSIONS: Rates of AR-BSI are substantially higher in CVC than AVF in contemporary HD despite advances in catheter design and anti-infective protocols. This pattern was consistent in all subgroups. The policy of AVF preference over CVC should continue to minimise patient morbidity while at the same time improving anti-infective strategies through better care protocols and infection surveillance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1253-x) contains supplementary material, which is available to authorized users. BioMed Central 2019-02-26 /pmc/articles/PMC6390569/ /pubmed/30808313 http://dx.doi.org/10.1186/s12882-019-1253-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Mohamed, Husham Ali, Alaa Browne, Leonard D. O’Connell, Nuala H. Casserly, Liam Stack, Austin G. Hussein, Wael F. Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study |
title | Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study |
title_full | Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study |
title_fullStr | Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study |
title_full_unstemmed | Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study |
title_short | Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study |
title_sort | determinants and outcomes of access-related blood-stream infections among irish haemodialysis patients; a cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390569/ https://www.ncbi.nlm.nih.gov/pubmed/30808313 http://dx.doi.org/10.1186/s12882-019-1253-x |
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