Bloodstream Infections In Hemodialysis Research Articles

Molecular Detection of Van A and bap Genes in Staphylococcus Species Isolated from Hemodialysis Patients with Blood Stream Infections

Abstract Background: Bloodstream infections (BSIs) are a frequent consequence of hemodialysis caused by bacterial pathogens associated with Staphylococcus spp. especially Staphylococcus aureus followed by coagulase-negative Staphylococci, which can produce biofilms, and also show its ability to increase resistance to vancomycin. Objectives: Estimate the percentage of Staphylococcus spp. associated with BSIs in hemodialysis (HD) patients. Study the antibiogram pattern of isolates and detection of the resistance gene van A and virulence bap gene. Materials and Methods: A total of 120 blood samples, 60 from patients on hemodialysis and 60 patients suspected of bacteremia, were collected. The isolation of bacteria was performed by blood samples inoculated in BacT/ALERT bottles and then subcultured on blood agar. Identification and antibiotic sensitivity testing detection were performed by the Vitek-2 system; then a conventional polymerase chain reaction for van A and bap genes was done. Results: The percentage of S. aureus was 64.7% within the group of HD patients followed by Staphylococcus lentus 11.8%, Staphylococcus hemolyticus 8.8%, and Staphylococcus hominis 5.9%, whereas in non-HD patients’ group, S. aureus was 50.0% and S. lentus 25.0%. All Staphylococcus spp. was completely resistant to vancomycin in HD and non-HD patients. The percentage of van A gene was 91.2% and 83.3% within HD and non-HD patients, respectively. The percentage of bap gene was 55.9% and 58.3% within HD and non-HD patients, respectively. Conclusion: Staphylococcus aureus is the most common bacterium that causes bacteremia in dialysis patients, while other types contribute with a lower frequency.

Incidence and Challenges in Management of Blood Stream Infections in Hemodialysis

Bloodstream infections pose a significant threat to patients undergoing hemodialysis, leading to hospitalizations, increased morbidity, and mortality. The Centers for Disease Control and Prevention (CDC) has prioritized the prevention of bloodstream infections in hemodialysis through their Making Dialysis Safer initiative.Most bloodstream infections linked to vascular access primarily occur in patients undergoing dialysis using central vein catheters. The Centers for Disease Control and Prevention (CDC) advocates core interventions as the best practices for catheter care in hemodialysis, demonstrating their effectiveness in reducing catheter-associated bloodstream infections. However, bloodstream infections linked to hemodialysis catheters persist at undesirable levels, it is likely due to failures in maintaining rigorous aseptic techniques or other factors beyond the scope of the CDC's core interventions. There is a urgent need for innovation of preventive measures. This review focuses on the current therapies, recent developments and also addresses potential drawbacks and adverse effects associated with thealternatives. This review also highlights the challenges and future perspectives which might prove to be beneficial in reducing infection rates in hemodialysis patients.

Analysis of pathogenic distribution and drug resistance of catheter-related blood stream infection in hemodialysis patients with vein tunneled cuffed catheter

The catheter related blood stream infections (CRBSI) in hemodialysis (HD) patients with vein tunneled cuffed catheter (TCC) and misuse of antibiotic in clinical practice seriously affected the prognosis of MHD patients. The present study aimed to investigate the pathogen distribution and drug resistance of CRBSI in HD patients with TCC to guide clinical empirical pharmacy. The clinical data of 75 HD patients with TCC diagnosed with CRBSI between January 2011 and March 2015 were retrospectively collected, and the distribution and drug resistance of pathogens were analyzed. In 75 HD patients with TCC diagnosed with CRBSI, there were 33 patients with positive blood culture, and the positive rate of blood culture was 44%. The majority of the 33 pathogens were Gram-positive bacteria (22 strains, accounting for 66.7%). Gram-positive cocci hardly resisted to vancomycin and linezolid, while the resistance rate to penicillin G nearly reached to 100%. Gram-negative bacilli had low resistance rates to carbapenems and quinolone antibiotics, and the resistance rate to cephalosporins antibioticsexceeding 50%. The positive rate of blood culture in 75 HD patients with TCC diagnosed with CRBSI is low. The pathogens resulting in CRBSI in HD patients are mainly Gram-positive bacteria which are significantly resistant to penicillin G, and have a low resistance rate to methicillin. Gram-negative bacteria have high resistance rates to commonly used antibiotics. The pathogen examination should be performed as early as possible and effective antibiotics should be chosen according to drug sensitivity test results in CRBSI in HD patients.

Progress in Preventing Bloodstream Infections in Hemodialysis: Data From the National Healthcare Safety Network, 2014–2018

Background: More than 450,000 patients receive outpatient hemodialysis in the United States. Patients on hemodialysis are at high risk of bloodstream infections (BSIs), which are associated with significant morbidity and mortality. National prevention efforts targeting hemodialysis facilities have resulted in widespread changes in practice, including modifications to central venous catheter (CVC) maintenance procedures. We analyzed dialysis event surveillance data submitted to the CDC NHSN to describe changes in BSI rates among hemodialysis outpatients from 2014 to 2018. Methods: Outpatient hemodialysis facilities report BSIs (ie, positive blood cultures collected in the outpatient setting or within 1 calendar day after hospital admission) and the number of hemodialysis outpatients treated during the first 2 working days of each month to the NHSN. For each BSI, the suspected source (ie, vascular access, another site, contamination, or uncertain) and vascular access type are indicated: CVC, arteriovenous fistula (AVF) or arteriovenous graft (AVG). Pooled mean rates (per 100 patient months) were calculated for BSIs, access-related BSIs (ARBSIs), and BSIs and ARBSIs were stratified by vascular access type. Annual BSI rate trends were evaluated using a negative binomial regression model, which treated patient months as an offset variable and included access type, year, and an access-year interaction variable. Results: More than 6,000 outpatient hemodialysis facilities reported 134,961 BSIs from 2014 to 2018. Of these BSIs, 102,505 (76%) were categorized as access related. CVCs were present in 63% of BSIs and 70% of ARBSIs. Pooled mean BSI rates decreased 27% from 0.64 to 0.47 per 100 patient months; rates of ARBSIs decreased 27% from 0.49 to 0.36 per 100 patient months. Significant decreases in event rates occurred across vascular access strata (Fig. 1). The reduction in BSI and ARBSI burden was most pronounced among patients with CVCs. BSI rates in patients with CVCs decreased 32% from 2.16 per 100 patient months to 1.46 (annual average decrease, 9.5%), and ARBSI rates in patients with CVCs decreased 32% from 1.83 per 100 patient months to 1.24 (annual average decrease, 9.4%). Conclusions: Substantial reductions in BSI and ARBSI rates among hemodialysis outpatients occurred during this 5-year period, and these reductions appear to be most prominent among CVC and AVF patients. Improvements in infection prevention and control practices, including CVC care, have likely contributed to these reductions. Additional efforts to increase the uptake of known prevention practices and to identify new strategies for prevention might contribute to continued decreases in infections among this highly vulnerable population.Funding: NoneDisclosures: None

1 LOCK-IT-100: CRMD003, A Novel Taurolidine-Based Catheter Lock Solution Reduces Catheter-Related Bloodstream Infections in Hemodialysis

1 LOCK-IT-100: CRMD003, A Novel Taurolidine-Based Catheter Lock Solution Reduces Catheter-Related Bloodstream Infections in Hemodialysis

Usefulness of endoluminal catheter colonization surveillance cultures to reduce catheter-related bloodstream infections in hemodialysis

To evaluate the use of surveillance cultures (SCs) to prevent catheter-related bloodstream infections (CRBSIs) in asymptomatic hemodialysis (HD) patients. In 2011-2012, we conducted a prospective study of HD patients with tunneled cuffed central venous catheters (TCCs). Colonization of the catheter lumen was assessed every 15 days by inoculating ~5 mL endoluminal blood into aerobic culture bottles. Individual patients were triaged based on SC results: group 1 (negative); group 2 (coagulase-negative Staphylococcus [CoNS] with time-to-positivity (TTP) >14 hours); group 3 (CoNS with TTP ≤14 hours); and group 4 (any microorganism other than CoNS and any TTP). We studied 104 patients (129 TCCs). Median follow-up was 262.5 days (interquartile range [IR], 135.0-365.0). A total of 1,734 SCs were collected (median, 18 per patient; IR, 10.0-24.0), of which 1,634 (94.2%) were negative (group 1) and 100 (5.8%) were positive (group 2: 79; group 3: 12, group 4: 9). In groups 2 and 3, 19 TCCs required antibiotic lock therapy (ALT). In group 4, all patients received intravenous therapy and ALT. Under this protocol, there were 0.27 episodes of CRBSI per 1,000 catheter days compared with 1.65 (P < .001) prior to its implementation. SCs based on easily accessible samples proved useful in triaging HD patients at a high risk of infection.

Survey of infection control practices in hemodialysis units: preventing vascular access-associated bloodstream infections.

Despite surveillance, the Quebec Healthcare-Associated Infections Surveillance Program saw no improvement in vascular access-associated bloodstream infections in hemodialysis (HD). We aimed to determine the infection control measures recommended and implemented in Quebec's HD units, compliance of local protocols to infection control practice guidelines, and reasons behind the low prevalence of arteriovenous fistulas. An online survey was elaborated on the basis of the Centers for Disease Control and Prevention (CDC) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. The questionnaire was validated (construct, content, face validity, and reliability) and sent to all HD units in Quebec (n = 40). Results were analyzed using descriptive statistics, linear regression, and Poisson regression. Thirty-seven (93%) of 40 HD units participated. Thirty (94%) of the 32 centers where central catheters are inserted have written insertion protocols. Compliance with practice guidelines is good, except for full-body draping during catheter insertion (79%) and ointment use at insertion site (3%). Prevention measures for catheter maintenance are in accordance with guidelines, except for skin disinfection with at least 0.5% chlorhexidine and 70% alcohol (67% compliance) and regular antiseptic ointment use at the insertion site (3%). Before fistula cannulation, skin preparation is suboptimal; forearm hygiene is performed in only 61% of cases. Several factors explain the low rate of fistulas, including patient preference (69%) and lack of surgical resources (39%; P = .01). Improvement in standardization of care according to practice guidelines is necessary. Fistula rate could be increased by improving access to surgical resources and patient education. Strategies are now being elaborated to address these findings.