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Catheter-Related Bloodstream Infections in Patients on Emergent Hemodialysis

Published online by Cambridge University Press:  26 November 2015

Christian A. Rojas-Moreno ,
Daniel Spiegel ,
Venkata Yalamanchili ,
Elizabeth Kuo ,
Henry Quinones ,
Pranavi V. Sreeramoju  and
James P. Luby
Christian A. Rojas-Moreno*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Daniel Spiegel
Affiliation:
University of Texas Southwestern Medical School, Dallas, Texas
Venkata Yalamanchili
Affiliation:
Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Elizabeth Kuo
Affiliation:
Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas Acute Dialysis Unit, Parkland Health and Hospital System, Dallas, Texas
Henry Quinones
Affiliation:
Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas Acute Dialysis Unit, Parkland Health and Hospital System, Dallas, Texas
Pranavi V. Sreeramoju
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas Department of Infection Prevention, Parkland Health and Hospital System, Dallas, Texas
James P. Luby
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
*
Address correspondence to Christian Rojas-Moreno, Division of Infectious Diseases, Department of Medicine, University of Missouri, One Hospital Dr, CE315, Columbia, MO 65212 (rojasch@health.missouri.edu).
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Abstract

OBJECTIVE

This study had 2 objectives: (1) to describe the epidemiology of catheter-related bloodstream infections (CRBSI) in patients with end-stage renal disease (ESRD) who have no access to scheduled dialysis and (2) to evaluate whether a positive culture of the heparin-lock solution is associated with subsequent development of bacteremia.

DESIGN

Retrospective observational cohort design for objective 1; and prospective cohort design for objective 2.

SETTING AND PARTICIPANTS

The study was conducted in a 770-bed public academic tertiary hospital in Dallas, Texas. The participants were patients with ESRD undergoing scheduled or emergent hemodialysis.

METHODS

We reviewed the records of 147 patients who received hemodialysis between January 2011 and May 2011 and evaluated the rate of CRBSI in the previous 5 years. For the prospective study, we cultured the catheter heparin-lock solution in 62 consecutive patients between June 2012 and August 2012 and evaluated the incidence of CRBSI at 6 months.

RESULTS

Of the 147 patients on emergent hemodialysis, 125 had a tunneled catheter, with a CRBSI rate of 2.61 per 1,000 catheter days. The predominant organisms were Gram-negative rods (GNR). In the prospective study, we found that the dialysis catheter was colonized more frequently in patients on emergent hemodialysis than in those on scheduled hemodialysis. Colonization with GNR or Staphylococcus aureus was associated with subsequent CRBSI at 6 months follow-up.

CONCLUSIONS

Patients undergoing emergent hemodialysis via tunneled catheter are predisposed to Gram-negative CRBSI. Culturing the heparin-lock solution may predict subsequent episodes of CRBSI if it shows colonization with GNR or Staphylococcus aureus. Prevention approaches in this population need to be studied further.

Infect. Control Hosp. Epidemiol. 2016;37(3):301–305

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 301 - 305
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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