Bloodstream infection among patients on hemodialysis by arteriovenous fistula and graft

Abstract

Arteriovenous (AV) graft or fistula is the major risk factor for bacteremia in hemodialysis (HD) patients. The present study was designed to evaluate the prevalence of risk factors for bloodstream infections (BSIs) among patients with AV graft or fistula for HD and to identify the microorganisms isolated from the bloodstream of patients. From May 2010 to May 2013, this retrospective study was performed. A questionnaire that included demographic and medical data was completed for each case. Also laboratory data, including catheter blood culture and peripheral blood cultures were collected for each case. The collected data were analyzed using SPSS software. A p value < 0.05 was considered significant. Overall, 106 cases received AV fistula and graft for HD in this study. Regarding the type of vascular access, 68 % had AV fistulas, 32 % had AV graft. A total of 49 episodes of BSIs were found in this study. These BSIs detected represent an incidence rate of 0.64/1,000 catheter days (0.65/1,000 catheter days in AV fistula and 0.64/1,000 catheter days in AV graft) and 2.56/1,000 dialysis sessions (2.49/1,000 dialysis sessions in AV fistula and 2.71/1,000 dialysis sessions in AV graft). Staphylococcus aureus was common pathogenic organism in BSIs. In the multivariable logistic regression model presence of diabetes mellitus, older age, low serum albumin level, and poor patient hygiene were all independently associated with occurrence of a BSI. Our data suggest that improved nutrition and hygiene and diabetes management in HD patients may decrease the incidence of bacteremia.