Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study.

Dayana Fram,Meiry Fernanda Pinto Okuno,Ricardo Sesso,Cibele Grothe,Silvia Regina Manfredi,Vinicius Ponzio,Angélica Belasco,Mônica Taminato,Mônica Taminato,Dulce Barbosa

doi:10.1186/s12879-015-0907-y

Abstract

BackgroundInfection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.MethodsRisk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.ResultsThere were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09).ConclusionsInfection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

Highlights

Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy
North American data indicate that bloodstream infection (BSI) rates in patients on hemodialysis vary between 0.5 and 27.1 per 100 patients/month depending on the type of venous access used [2]
For common skin commensal pathogens (Staphylococcus coagulase negative including Staphylococcus epidermidis), we considered BSI when pathogens were cultured from two or more blood cultures and/or the patient was treated by a physician [17,18]

Summary

Introduction

Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. The mortality rate from infectious causes decreased from 43 to 19.4 deaths per 1000 patients/year [1]. More recent studies report a reduction in the incidence of BSI in this population between 1.09–0.89 and 2.04–0.75 per 100 patients/ month after implementation of specific control measures [3,4]. This decrease was attributed to national initiatives for the reduction of healthcare-related infections [5]

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