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A prospective study of vascular access infections at seven outpatient hemodialysis centers.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2001 Jun; Vol. 37 (6), pp. 1232-40. - Publication Year :
- 2001
-
Abstract
- Vascular access infections are a major cause of morbidity and mortality in hemodialysis patients, and the use of antimicrobials to treat such infections contributes to the emergence and spread of antimicrobial-resistant bacteria. To determine the incidence of and risk factors for vascular access infections, we studied hemodialysis patients at 7 outpatient dialysis centers (4 in Richmond, VA, and 3 in Baltimore, MD) during December 1997 to July 1998. Vascular access infections were defined as local signs (pus or redness) at the vascular access site or a positive blood culture with no known source other than the vascular access; and hospitalization or receipt of an intravenous (IV) antimicrobial. A total of 796 patients were followed for 4,134 patient-months. The vascular access infection rate was 3.5/100 patient-months, ie, patients had a 3.5% risk of infection each month. Independent risk factors were the specific dialysis unit where the patient was treated (relative hazard varying from 1.0 to 4.1 among the 7 centers), catheter access (relative hazard, 2.1 v implanted access), albumin level (relative hazard, 2.4 for lowest v highest quartile), urea reduction ratio (relative hazard, 2.2 for lowest v highest quartile), and hospitalizations during the previous 90 days (relative hazard, 4.9 for >/=6 v zero hospitalizations). These data confirm that vascular access infections are common in hemodialysis patients and that infection rates differ substantially among different centers. Catheter use should be minimized to reduce these infections. Additionally, the possibility that improved serum albumin and urea reduction ratio could reduce vascular access infections should be evaluated.
- Subjects :
- Aged
Anti-Bacterial Agents pharmacology
Bacteremia drug therapy
Bacteremia etiology
Bacteria drug effects
Bacteria isolation & purification
Bacterial Infections complications
Bacterial Infections drug therapy
Cohort Studies
Female
Humans
Kidney Failure, Chronic therapy
Male
Middle Aged
Prospective Studies
Risk Factors
Ambulatory Care Facilities statistics & numerical data
Bacterial Infections microbiology
Kidney Failure, Chronic microbiology
Renal Dialysis instrumentation
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 37
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 11382693
- Full Text :
- https://doi.org/10.1053/ajkd.2001.24527