The Spectrum of Infections in Catheter-Dependent Hemodialysis Patients
The Spectrum of Infections in Catheter-Dependent Hemodialysis Patients
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DOI：
10.2215/cjn.03900411
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发表时间：
2011-09-01
影响因子：
9.8
通讯作者：
Allon, Michael
中科院分区：
文献类型：
--
作者：
Al-Solaiman, Yaser;Estrada, Erin;Allon, Michael
背景和目的导管依赖性血液透析患者可能发生通路相关和非通路相关感染，这些感染可在门诊竞技场或医院进行治疗。本研究的目的是量化感染，在这样的患者，以表征他们的临床表现，并评估因素确定需要住院治疗。设计，设置，参与者，和测量我们收集的前瞻性数据的临床管理的导管依赖性血液透析患者怀疑感染在一个大型透析中心。我们记录了目前的症状，感染类型，病原体，以及是否住院happened.Results感染被怀疑在305个独立的情况下，并确认在88%。268例确诊感染包括导管相关菌血症（69%）、其他入路相关感染（19%）和非入路相关感染（12%）。感染的总频率为4.62/1000导管-天。所有感染中有37%发生住院，但差异很大（非穿刺相关感染为72%，导管相关菌血症为34%，出口部位感染为4%）。在导管相关菌血症患者中，不同病原体导致住院的可能性不同，金黄色葡萄球菌为53%，肠球菌为30%，表皮葡萄球菌为23%，革兰氏阴性杆菌为17%（P < 0.001）。住院的可能性与年龄、性别或糖尿病无关。发热是一个目前的症状，只有47%的情况下，导管相关bacteriemia.Conclusions导管依赖患者有很高的感染负担。对疑似感染患者进行各种入路相关和非入路相关感染的评价非常重要。怀疑导管相关菌血症的阈值较低，因为患者通常不发热。Clin I Am Soc Nephrol 6：2247-2252，2011. doi：10.2215/CJN.03900411
Background and objectives Catheter-dependent hemodialysis patients may develop access-related and non-access-related infections that may be managed in the outpatient arena or in the hospital. The goal of this study was to quantify infections in such patients, to characterize their clinical presentations, and to evaluate factors determining need for hospitalization.Design, setting, participants, & measurements We collected prospective data on the clinical management of catheter-dependent hemodialysis patients with suspected infection at a large dialysis center. We documented the presenting symptoms, type of infection, pathogen, and whether hospitalization occurred.Results An infection was suspected in 305 separate cases and confirmed in 88%. The 268 diagnosed infections included catheter-related bacteremia (69%), another access-related infection (19%), and nonaccess-related infection (12%). The overall frequency of infection was 4.62 per 1000 catheter-days. Hospitalization occurred in 37% of all infections, but it varied greatly (72% for nonaccess-related infection, 34% for catheter-related bacteremia, and 4% for exit-site infection). Among patients with catheter-related bacteremia, the likelihood of hospitalization varied by pathogen, being 53% for Staphylococcus aureus, 30% for Enterococcus, 23% for Staphylococcus epidermidis, and 17% for gram-negative rods (P < 0.001). The likelihood of hospitalization was not associated with age, gender, or diabetes. Fever was a presenting symptom in only 47% of cases of catheter-related bacteremia.Conclusions Catheter-dependent patients have a high burden of infection. It is important to evaluate patients with suspected infection for various access-related and nonaccess-related infections. A low threshold is indicated for suspecting catheter-related bacteremia because the patients frequently present without fever. Clin I Am Soc Nephrol 6: 2247-2252, 2011. doi:10.2215/CJN.03900411