Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias

Nephron. 2002 Jul;91(3):399-405. doi: 10.1159/000064279.

Abstract

Infection, mainly related to vascular access, is one of the main causes of morbidity and a preventable cause of death in hemodialysis patients. From January 1994 to April 1998 we conducted a prospective study to assess the incidence and risk factors of catheter-related bacteremia. One hundred and twenty-nine tunneled dual-lumen hemodialysis catheters were inserted percutaneously into the internal jugular vein in 89 patients. Bacteremia (n = 56) occurred at least once with 37 (29%) of the catheters (an incidence of 1.1/1,000 catheter-days); local infection (n = 45, 1/1,000 catheter-days) was associated with bacteremia in 18 cases. Death in 1 case was directly related to Staphylococcus aureus (SA) septic shock, and septicemia contributed to deaths in 2 additional cases. Catheters were removed in 48% of the bacteremic episodes. Treatment comprised intravenous double antimicrobial therapy for 15-20 days. Bacteriological data of bacteremia showed 55% involvement of SA. Nasal carriage of SA was observed in 35% of the patients with catheters. Bacteremic catheters were more frequently observed in patients with diabetes mellitus (p = 0.03), peripheral atherosclerosis (p = 0.001), a previous history of bacteremia (p = 0.05), nasal carriage of SA (p = 0.0001), longer catheter survival time (p = 0.001), higher total intravenous iron dose (p = 0.001), more frequent urokinase catheter infusion (p < 0.01), and local infection (p < 0.001) compared with non-bacteremic catheters. Monovariate survival analysis showed that significant initial risk factors for bacteremia were nasal carriage of SA (p = 0.00001), previous bacteremia (p = 0.0001), peripheral atherosclerosis (p = 0.005), and diabetes (p = 0.04). This study confirms the relatively high incidence of bacteremia with tunneled double-lumen silicone catheters and its potential complications. Possible preventive actions are discussed according to the risk factors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteremia / epidemiology
  • Bacteremia / etiology*
  • Carrier State
  • Catheterization, Central Venous / adverse effects*
  • Catheters, Indwelling / adverse effects
  • Catheters, Indwelling / microbiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasal Cavity / microbiology
  • Prospective Studies
  • Renal Dialysis / methods*
  • Renal Dialysis / mortality
  • Risk Factors
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / etiology*
  • Staphylococcus aureus / isolation & purification
  • Staphylococcus aureus / physiology