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, 11 (1), 29

Rate of Bacteremia in the Hemodialysis Patient Presenting to the Emergency Department With Fever: A Retrospective Chart Review


Rate of Bacteremia in the Hemodialysis Patient Presenting to the Emergency Department With Fever: A Retrospective Chart Review

Nicholas Villalon et al. Int J Emerg Med.


Background: Infectious disease is the second most common cause of death in patients receiving hemodialysis (HD). When presenting to the emergency department (ED) with fever, it remains a diagnostic challenge to distinguish patients with potentially life-threatening bacterial infections from those with less significant causes of fever. The primary goal of this study was to determine the rate of bacteremia in HD patients presenting to the ED with fever. The secondary goal of this study was to identify any independent risk factors associated with bacteremia in the febrile HD patient.

Methods: This is a retrospective medical record review of all HD patients who presented to the ED with either subjective fever as primary complaint or with a documented triage temperature of 38 °C or higher during the 3-year period between September 1, 2014, and September 1, 2017. Patient visits were included in the study if blood cultures were ordered in the ED. Data related to demographic information, clinical parameters, diagnostic test results in the ER, final diagnosis, and results of microbiology cultures were collected from each patient encounter. Univariate analysis was performed to identify risk factors associated with bacteremia.

Results: We identified 353 patient visits from 138 unique patients that met inclusion criteria. Fifty-eight percent of these were women, and the average age was 54.6 years. The rate of bacteremia was 31.7%, and the main microorganisms isolated in blood culture were non-MRSA Staphylococcus aureus (40.7%), MRSA (13.3%), Pseudomonas aeruginosa (11.5%), and Enterobacter spp. (11.5%). Independent prognostic factors associated with bacteremia were use of dialysis catheter, prior history of bacteremia, and > 5% neutrophilic band cells (OR 6.55 [95% CI 3.96-10.8; p < 0.0001]; OR 8.87 [95% CI 5.32-14.8; p < 0.0001]; OR 3.32 [95% CI 1.90-5.80; p < 0.0001] respectively).

Conclusion: HD patients presenting to the ED with fever have high rates of bacteremia, with a significantly higher rate in patients using dialysis catheters or those with a history of bacteremia. Other clinical data available in the ED is minimally useful in predicting bacteremia.

Keywords: Bacteremia; Emergency department; Febrile; Fever; Hemodialysis; Sepsis.

Conflict of interest statement

Ethics approval and consent to participate

Because our institution has no internal institutional review board, we gained approval for this retrospective chart review from Western IRB (Puyallup, WA) protocol number 2016000.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Relative risk for bacteremia

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    1. Lafrance JP, Rahme E, Lelorier J, Iqbal S. Vascular access-related infections: definitions, incidence rates, and risk factors. Am J Kidney Dis. 2008;52(5):982–993. doi: 10.1053/j.ajkd.2008.06.014. - DOI - PubMed
    1. Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000;58(4):1758–1764. doi: 10.1111/j.1523-1755.2000.00337.x. - DOI - PubMed
    1. Ponce P, Cruz J, Ferreira A, Oliveira C, Vinhas J, Silva G, Pina E. A prospective study on incidence of bacterial infections in Portuguese dialysis units. Nephron Clin Pract. 2007;107(4):c133–c138. doi: 10.1159/000110033. - DOI - PubMed
    1. O’Seaghdha CM, Foley RN. Septicemia, access, cardiovascular disease, and death in dialysis patients. Perit Dial Int. 2005;25:534. - PubMed
    1. Evers J. Approach to fever in dialysis patients. Nephron. 1995;69(1):110. doi: 10.1159/000188380. - DOI - PubMed