Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis

Int J Med Sci. 2013 Sep 20;10(12):1632-8. doi: 10.7150/ijms.6710. eCollection 2013.


Objectives: Infection is a common cause of death among hemodialysis patients. The study investigated incidence, risk factors, clinical features and outcome of bloodstream infections (BSIs) in haemodialysis patients.

Methods: The records of haemodialysis patients from 1999 to 2005 were reviewed. Risk factors were investigated by multivariate analysis.

Results: There were identified 148 bacteremic episodes, in 102 patients. The BSI rate was 0.52 per 1000 patient-days. Of the 148 episodes, 34 occurred in patients with permanent fistulae (0.18/1000 patient-days); 19 in patients with grafts (0.39/1000 patient-days); 28 in patients with permanent tunneled central catheters (1.03/1000 patient-days); and 67 in those with temporary-catheter (3.18/1000 patient-days). With fistula as reference, the BSI ratio was 1.84 with arteriovenous graft (P=.029), 4.85 with permanent central venous catheter (P<.001), and 14.88 with temporary catheter (P <.001). Catheter related were 41 episodes (28%). Gram positive organism were responsible for 96 episodes (65%), with S. aureus ( 55%) the most frequent, followed by S. epidermidis (26%) and Gram-negative for 36 (23%), with E. coli (39%) the most frequent. Infection was polymicrobial in 14 (9.5%). Diabetes (p<0.001), low serum albumin (p=0.040) and low hemoglobin (p<0.001) were significant risk factors. During hospitalization 18 patients (18%) died. Septic shock (p<0.001) and polymicrobial infection (p=0.041) were associated with in-hospital mortality.

Conclusion: The risk of BSI in patients undergoing hemodialysis is related to the catheter type and vascular access. Septic shock and polymicrobial infection predispose to unfavourable outcome.

Keywords: Antimicrobial Resistance; Epidemiology; Sepsis; Vascular Catheter-Related Infections.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Bacteremia / pathology
  • Catheter-Related Infections / blood
  • Catheter-Related Infections / embryology*
  • Catheter-Related Infections / microbiology*
  • Catheter-Related Infections / pathology
  • Escherichia coli / isolation & purification
  • Escherichia coli / pathogenicity
  • Female
  • Humans
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Risk Factors
  • Staphylococcus aureus / isolation & purification
  • Staphylococcus aureus / pathogenicity