Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing haemodialysis
Abstract number: P1191
Kofteridis D., Fysaraki M., Valachis A., Christofaki M., Aristeidou I., Mattheou C., Daphnis E., Samonis G.
Objectives: To determine the incidence, risk factors, clinical features and outcome of bloodstream infections in patients undergoing haemodialysis.
Materials and Methods: The records of all patients who had undergone haemodialysis at the University Hospital of Heraklion, from 1999 to 2005 were retrospectively reviewed. Multivariate analysis was used to identify risk factors among patients developing dialysis-associated bacteraemia.
Results: One hundred forty eight bacteraemic episodes, occurring in 102 patients, were identified. Their median age was 70 years (range 2090). There were 53 (52%) women. The bloodstream infection rate was 0.52 per 1000 patient-days. Of the 148 episodes, 34 occurred in patients with permanent fistulae (0.18/1000 patient-days); 19 in patients with grafts (0.39/1000 patient-days); 28 in patients with permanent tunnelled central catheters (1.03/1000 patient-days); and 67 in those with temporary-catheter (3.18/1000 patient-days). The relative risk for bloodstream infection of patients having artero-venous graft access was 1.84 (p=.029), for those with permanent central venous catheter 4.85 (p < 0.001), and for those with temporary catheter 14.88 (p < 0.001). Forty one episodes (28%) were catheter related. Gram positive bacteria were responsible for 96 episodes (65%), with S. aureus (53 out of 96; 55%) being the most frequent, followed by S. epidermidis (25 out of 96; 26%). Gram-negative organisms were responsible for 36 episodes (23%), with E. coli (14 out of 36; 39%) being the most frequent. In 14 episodes (9.5%) the infection was polymicrobial. Diabetes (p = 0.005), low serum albumin (p = 0.040) and low haemoglobin (p = 0.005) were significant risk factors for bacteraemia. Eighteen patients (18%) died during hospitalisation. Multivariate logistic regression analysis has shown that septic shock (p < 0.001) and polymicrobial infection (p=.041) were associated with in-hospital mortality. Mortality was not associated with the type of microorganisms involved.
Conclusion: The risk of bloodstream infection in patients undergoing haemodialysis is related to the type of catheter and vascular access. Presence of septic shock and polymicrobial infections predispose to unfavourable outcome.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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