Dialysis Catheter-related Infections Research Articles

Staphylococcus aureus bacteraemia among patients undergoing dialysis--focus on dialysis catheter-related cases.

Central venous catheter-related infections are the most common cause of nosocomial S. aureus bacteraemia in Denmark. Central venous catheters are often used for dialysis, and patients on dialysis often run into staphylococcal infections. The purpose of this study was to investigate S. aureus bacteraemia among dialysis patients, especially those related to dialysis catheters. This was a retrospective study of 14,387 consecutive S. aureus bacteraemia cases during the period 1976-93, of which 793 cases occurred among dialysis patients. By reviewing the case records, 65 dialysis catheter-related cases were described more thoroughly. The number of S. aureus bacteraemia cases among dialysis patients as a proportion of all cases in Denmark has increased from 5.2 to 14.7% during the study period, but the annual incidence among these patients has been almost stable during the period (median 5.7% (3.2-9.0%)). Patients on dialysis had a lower mortality than other patients with S. aureus bacteraemia (18.9 vs 29.0%), but a four times higher mortality from central venous catheter-related S. aureus bacteraemia (5.3 vs 1.3%, P < 0.001). The mortality from dialysis catheter-related S. aureus bacteraemia was correlated with greater age (median 71 years (57-73) vs median 56.5 years (15-76), P < 0.01) and with septic shock (55.5 vs 7.1%, P < 0.05). Patients on dialysis had a lower frequency of S. aureus endocarditis (3.3 vs 5.4%, P < 0.01) and of S. aureus bone and joint infections (3.3 vs 8.2%, P < 0.001) than other patients. Patients undergoing dialysis had a later onset of catheter-related S. aureus bacteraemia than other patients (median 15 days (1-145) vs 5 days (1-134), P < 0.05). Patients on dialysis are at a high risk of S. aureus bacteraemia and they have a four times higher mortality from central venous catheter-related S. aureus bacteraemia than other patients. There is need for prospective studies in which patients as well as catheters are followed more thoroughly to study the pathogenesis of dialysis catheter-related infections.

Mucormycosis: Emerging Prominence of Cutaneous Infections

Twenty-five patients with mucormycosis were seen at two university-affiliated hospitals from 1979 to 1993. These cases included 10 cutaneous, 9 rhinocerebral, and 3 disseminated infections, as well as one case each of pulmonary, renal, and peritoneal dialysis catheter-related infection. Eleven of the patients were diabetic and seven had ketoacidosis, including four who became acidotic after admission to the hospital. The mortality rates associated with rhinocerebral, disseminated, and pulmonary infections were 78%-100%, while those associated with cutaneous and miscellaneous forms were zero. In view of the prominence of cutaneous infections, the 10 cases of cutaneous mucormycosis (in addition to a case from a community hospital) are reported in detail. Systemic diseases were present in four of the 11 patients. Local factors leading to infection were identified in nine of the cases and included motor vehicle accident-related and other trauma, surgery, a spider bite, and an intravenous infusion catheter. The cases of cutaneous mucormycosis reported in the literature have been analyzed for identification of predisposing factors, treatment, and outcome. Aggressive surgical debridement is the most important component of therapy, and administration of amphotericin B is a useful adjunct. Skin grafting is useful as a method of repairing defects left by extensive debridement.

Prevention of Postoperative Peritoneal Dialysis Catheter-Related Infections

Catheter-related infections represent a significant complicaton of peritoneal dialysis therapy for end-stage renal disease, and may even supplant peritonitis as the Achilles’ heel. While the true incidence of all types of postoperative catheter-placement infections is unknown, it is reported that approximately 10% of exit-site infections occur in the immediate postoperative period, prior to healing and the establishment of barriers to microorganism invasion. Generally, little attention is given to this fact, and there exists no standardized procedure for the care of the operative wound and exit site. We evaluated a postoperative catheter-care protocol in 111 consecutive catheter placements. Ninety-seven were placed surgically and 14 with a peritoneoscope. Emphasizing strict aseptic technique, catheter immobilization, and avoidance of contamination, we observed no early and only two late postoperative infections. Our patients were from two different medical centers and we did not attempt to control for exit-site location, type of catheter, or technique and location of placement. Prophylactic antibiotics were utilized in 88%. We believe that our protocol was responsible for our low postoperative infection rate.

Prevention of peritoneal dialysis catheter-related infections.

There is a significant correlation between patient morbidity and peritoneal dialysis-associated catheter-related infections. Infection occurs when barriers to microorganism invasion are disrupted. To establish and maintain strong barriers against this invasion, care must be taken with placement of the catheter and with short- and long-term maintenance. There must be particular emphasis on planning placement of the catheter. Exit-site selection, type and configuration of the catheter, whether the catheter will contain one or two cuffs, and whether placement will be midline or lateral are all important factors to be considered. Tips are offered to enhance barrier establishment as the catheter is placed, as is a discussion of postplacement exit-site and wound care, and exit-site care after healing has occurred. Finally, the importance of recognizing catheter-related infections is emphasized and four types of infection are defined. Given the anecdotal nature of much of the material presented and the lack of well-defined clinical research on the subject, carefully designed randomized prospective studies are needed to determine the best method for both catheter placement and maintenance.

Incidence of subclavian dialysis catheter-related infections

• Since 1981, we have performed more than 1,300 dialyses in 74 patients who have had subclavian dialysis catheters (SDCs) in place for a total of 3,065 days. Sixty-one (82%) of these patients have had their SDCs in place for seven to 21 days, including 37 (50%) for longer than 21 days. We have had six culture-proved and three possible (culture-negative) cases of SDC-related infections.Staphylococcus aureus(four cases) andStaphylococcus epidermidis(two cases) were the only organisms isolated. These infections were easily managed with antibiotics and removal of the SDC. There were no infection-related deaths. We believe that the SDC is a safe means of administering hemodialysis. (Arch Intern Med1984;144:1787-1789)

Incidence of subclavian dialysis catheter-related infections

Incidence of subclavian dialysis catheter-related infections