Clinical Characteristics and Outcome of Vascular Access Infections in Hemodialysis Patients

Se Yoon Park; Eun Jung Lee; Tae Hyong Kim; Min Huok Jeon; Eun Ju Choo

doi:10.3947/ic.2011.43.4.343

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Park, Lee, Kim, Jeon, and Choo: Clinical Characteristics and Outcome of Vascular Access Infections in Hemodialysis Patients

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2011; 43(4): 343-348.

Published online: 31 August 2011

DOI: https://doi.org/10.3947/ic.2011.43.4.343

Clinical Characteristics and Outcome of Vascular Access Infections in Hemodialysis Patients

Se Yoon Park, Eun Jung Lee, Tae Hyong Kim

, Min Huok Jeon, Eun Ju Choo

Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Seoul, Korea.

Correspondence to Eun Ju Choo, M.D. Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon 420-767, Korea. Tel: +82-32-621-5202, Fax: +82-32-621-5016, mdchoo@schmc.ac.kr

Received 20 April 2011 Revised 12 July 2011 Accepted 21 July 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients.

Materials and Methods

Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access.

Results

Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28 (12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%) had a temporary central catheter. The mean±SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6±36.9 days, tunneled cuffed catheter 180.3±168.8 days, AV fistulas 928.6±1,299.7 days, and AV graft 1,066.3±1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%; methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%), tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12, 33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%.

Conclusions

Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.

Keywords: Catheter-related infections, Hemodialysis

Figures and Tables

Figure 1

Proportion of sepsis and severe sepsis among those hospitalized with vascular access infection by type of vascular access.

AV, arteriovenous; CVC, central venous catheter.

Table 1

Baseline Characteristics of Patients by Vascular Access Type

Age, Duration of HD is expressed as the mean±standard deviation.

P value=^a0.416, ^b0.119, ^c0.006.

^dTuberculosis include both past history of clinical infection and radiological evidence of old tuberculosis.

HD, hemodialysis; VA, vascular access; DM, diabetes mellitus; GN, glomerulonephritis; PCKD, polycystic kidney disease; CAD, conoronary artery disease; CHF, congestive heart failure; AV, arteriovenous; SIRS, systemic inflammatory response syndrome.

Table 2

Organisms Isolated from Blood and Vascular Access

MRSA, methicillin-resistant staphylococcus aureus; MSSA, methicillin-susceptible Staphylococcus aureus; MRCoNS, methicillin-resistant coagulase negative staphylococci; MSCoNS, methicillin-susceptible coagulase negative staphylococci; spp., species.

Table 3

Major Complications of Vascular Access Infection by Vascular Access Type

AV, arteriovenous; SPE, septic pulmonary embolism; CVA, cerebrovascular accidents.

Table 4

Vascular Access Infection Related of Complications by Causative Organisms

CI, confidence interval; SPE, septic pulmonary embolism; MSSA, methicillin-susceptible Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus.

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ORCID iDs: Tae Hyong Kim
https://orcid.org/http://orcid.org/0000-0003-2920-9038
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