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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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References

REFERENCES

1. Campbell, GA, Sanoff, S, Rosner, MH. Care of the undocumented immigrant in the United States with ESRD. Am J Kidney Dis 2010;55:181–191.CrossRefGoogle ScholarPubMed
2. Raghavan, R. When access to chronic dialysis is limited: one center’s approach to emergent hemodialysis. Semin Dial 2012;25:267–271.CrossRefGoogle ScholarPubMed
3. Straube, BM. Reform of the US healthcare system: care of undocumented individuals with ESRD. Am J Kidney Dis 2009;53:921–924.CrossRefGoogle ScholarPubMed
4. Raghavan, R, Nuila, R. Survivors—dialysis, immigration, and U.S. law. N Engl J Med 2011;364:2183–2185.CrossRefGoogle ScholarPubMed
5. Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–1171.CrossRefGoogle ScholarPubMed
6. Beathard, GA. Catheter management protocol for catheter-related bacteremia prophylaxis. Semin Dial 2003;16:403–405.CrossRefGoogle ScholarPubMed
7. Saad, TF. Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis 1999;34:1114–1124.CrossRefGoogle ScholarPubMed
8. Marr, KA, Sexton, DJ, Conlon, PJ, et al. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997;127:275–280.CrossRefGoogle ScholarPubMed
9. Ali, D, Kuo, E, Quinones, H, et al. Impact of enhanced infection control practices on access infections in an acute dialysis unit. In: Programs and Abstracts of Kidney Week 2012; October 30–November 4, 2012; San Diego, CA. Abstract TH-PO238.Google Scholar
10. Tenney, JH, Moody, MR, Newman, KA, et al. Adherent microorganisms on lumenal surfaces of long-term intravenous catheters. Importance of Staphylococcus epidermidis in patients with cancer. Arch Intern Med 1986;146:1949–1954.CrossRefGoogle ScholarPubMed
11. Raad, I, Costerton, W, Sabharwal, U, et al. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 1993;168:400–407.CrossRefGoogle ScholarPubMed
12. Anaissie, E, Samonis, G, Kontoyiannis, D, et al. Role of catheter colonization and infrequent hematogenous seeding in catheter-related infections. Eur J Clin Microbiol Infect Dis 1995;14:134–137.CrossRefGoogle ScholarPubMed
13. Dittmer, ID, Sharp, D, McNulty, CA, et al. A prospective study of central venous hemodialysis catheter colonization and peripheral bacteremia. Clin Nephrol 1999;51:34–39.Google ScholarPubMed
14. Rosenbaum, D, MacRae, JM, Djurdjev, O, et al. Surveillance cultures of tunneled cuffed catheter exit sites in chronic hemodialysis patients are of no benefit. Hemodial Int 2006;10:365–370.CrossRefGoogle ScholarPubMed
15. Nielsen, J, Kolmos, HJ, Rosdahl, VT. Poor value of surveillance cultures for prediction of septicaemia caused by coagulase-negative staphylococci in patients undergoing haemodialysis with central venous catheters. Scand J Infect Dis 1998;30:569–572.Google ScholarPubMed
16. Rodriguez-Aranda, A, Alcazar, JM, Sanz, F, et al. Endoluminal colonization as a risk factor for coagulase-negative staphylococcal catheter-related bloodstream infections in haemodialysis patients. Nephrol Dial Transplant 2011;26:948–955.CrossRefGoogle ScholarPubMed
17. Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1–45.CrossRefGoogle ScholarPubMed
18. Hall, KK, Lyman, JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;19:788–802.CrossRefGoogle ScholarPubMed
19. Do, AN, Ray, BJ, Banerjee, SN, et al. Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. J Infect Dis 1999;179:442–448.CrossRefGoogle ScholarPubMed
20. Ramanathan, V, Riosa, S, Al-Sharif, AH, et al. Characteristics of biofilm on tunneled cuffed hemodialysis catheters in the presence and absence of clinical infection. Am J Kidney Dis 2012;60:976–982.CrossRefGoogle ScholarPubMed