Risk factors for catheter-related infections in patients receiving permanent dialysis catheter

被引:26
作者
Delistefani, Fani [1 ]
Wallbach, Manuel [1 ]
Mueller, Gerhard A. [1 ]
Koziolek, Michael J. [1 ]
Grupp, Clemens [1 ,2 ]
机构
[1] Georg August Univ, Univ Med Ctr Gottingen, Dept Nephrol & Rheumatol, Robert Koch Str 40, D-37099 Gottingen, Germany
[2] Acad Teaching Hosp Bamberg, Dept Nephrol & Hypertens, Bugerstr 80, D-96049 Bamberg, Germany
关键词
Catheter related complication; CRP; Germ carriage; Hemodialysis; MRSA; Tunneled catheter; RESISTANT STAPHYLOCOCCUS-AUREUS; CHRONIC-HEMODIALYSIS PATIENTS; SURGICAL-SITE INFECTIONS; C-REACTIVE PROTEIN; VASCULAR ACCESS; NASAL CARRIAGE; BACTEREMIA; MORTALITY; HOSPITALIZATION; COMPLICATIONS;
D O I
10.1186/s12882-019-1392-0
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Due to rising vascular comorbidities of patients undergoing dialysis, the prevalence of permanent hemodialysis catheters as hemodialysis access is increasing. However, infection is a major complication of these catheters. Therefore, identification of potential predicting risk factors leading to early infection related complications is valuable, in particular the significance the CRP (C-reactive protein)-value is of interest. Methods: In this retrospective study 151 permanent hemodialysis catheters implanted in 130 patients were examined. The following data were collected at the time of catheter implantation: CRP-value, history of catheter-related infection, microbiological status, immunosuppression and diabetes mellitus. The primary outcomes were recorded over the 3months following the implantation: catheter-related infection, days of hospital stay and death. Catheter removal or revision, rehospitalization and use of antibiotics were identified as secondary outcomes. Results: We identified a total of 27 (17.9%) infections (systemic infection: 2.26 episodes/ 1000 catheter days, local infection: 0.6 episodes/ 1000 catheter days). The development of an infection was independent of the CRP-value (p=0.66) as well as the presence of diabetes mellitus (p=0.64) or immunosuppression (p=0.71). Univariate analysis revealed that infection was more frequent in patients with MRSA-carriage (p<0.001), in case of previous catheter-related infection (p<0.05) and of bacteremia or bacteriuria in the period of 3months before catheter implantation (p<0.001). Catheter removal or revision (p=0.002), rehospitalization (p=0.001) and use of antibiotics (p=0.02) were also more often observed in patients with MRSA-carriage. Conclusions: The CRP-value at the time of implantation of a permanent hemodialysis catheter is not associated with the development of early catheter related infections, but an individual history of catheter-related infection, MRSA-carriage and bacteremia or bacteriuria in the period of 3months prior to catheter implantation are significant risk factors.
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