Main Article Content
Abstract
Infection of catheters for hemodialysis is one of the major causes of morbidity and mortality. The intuitive hypothesis that catheters become more infected during hospitalization has not been verified in the literature.
Objective: To know if hospitalization is a risk factor for catheter-related bacteraemia.
Material and Method: Retrospective analysis of catheter-associated bacteraemias in dialysis center dependent on a Nephrology Department of a third level hospital during the 2014-2017 period. Catheter use times and catheter-related bacteraemias were divided into 2 scenarios: hospital and dialysis center. The Poisson Regression Model was applied to compare bacteremia in hospital and dialysis center. The same patient could suffer bacteremia more than once and in both scenarios.
Results: 361 catheters were used in 174 patients with a total time of use of 91,491 days, with 103 episodes of bacteraemia. Bacteremia rates: in hospital was 7.81/1000 days/catheter and in dialysis center was 0.81/1000 days/catheter. The risk of bacteraemia was multiplied by 9.6 during hospitalization versus dialysis center (p <0.001).
Conclusions: The risk of catheter-related bacteraemia increases when patients are hospitalized. Circumstances related to hospitalization are risk factors. Although the greater comorbidity of these patients may partly explain the higher incidence of bacteraemias, the optimization of nursing care -for uninhabited personnel- is the focus of improvement, according to our results
Keywords
Article Details
Author copyright notice
© Authors grant the publisher the non-exclusive licence to publish the work and consent to its use and distribution under the Creative Commons Attribution - NonCommercial 4.0 International (CC BY-NC 4.0) licence. Read the licensing information and the legal text here. This must be expressly stated wherever necessary.
References
- Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al. Guía Clínica Española del Acceso Vascular para Hemodiálisis. Nefrología [Internet]. 2017;37(November):1-193. [Consultado 14 abril 2018]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0211699517302175.
- Andreu D, Ángel M, Blanco H. Eventos infecciosos en pacientes en hemodiálisis. 2015;54-6.
- Cobo PA, Clave P, Vascular-Catéter:-Bacteriemia-Acceso. Prevalencia de bacteriemias relacionadas con el catéter de hemodiálisis en una unidad hospitalaria. Enferm Nefrol Octubre-Diciembre [Internet]. 2013;16(4):229-34. [Consultado 14 abril 2018]. Disponible en: http://scielo.isciii.es/pdf/enefro/v16n4/original2.pdf.
- Ferrer C, Almirante B. Infecciones relacionadas con el uso de los cateteres vasculares. Enferm Infecc Microbiol Clin. 2014;32(2):115-24.
- Albalate M, García RP, de Sequera P, Alcázar R, Puerta M, Ortega M, et al. ¿Hemos olvidado lo más importante para prevenir las bacteriemias en pacientes portadores de catéteres para hemodiálisis?. Nefrologia. 2010;30(5):573-7.
- Roca-Tey R, Arcos E, Comas J, Cao H, Tort J. Vascular access for incident hemodialysis patients in Catalonia: analysis of data from the Catalan Renal Registry (2000-2011). J Vasc Access. 2015;16(6):472-9.
- Gruss E, Portoles J, Caro P, Merino JL, López-Sánchez P, Tato A, et al. Los modelos de atención al acceso vascular condicionan resultados heterogéneos en los centros de una misma comunidad. Nefrologia. 2010;30(3):310-6.
- Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2008 Oct;23(10):3219-26.
- Zhang HH, Cortes-Penfield NW, Mandayam S, Niu J, Atmar RL, Wu E, et al. Dialysis Catheter-related Bloodstream Infections in Patients Receiving Hemodialysis on an Emergency-only Basis: A Retrospective Cohort Analysis. Clin Infect Dis. 2019 Mar;68(6):1011-6.
- Suzuki M, Satoh N, Nakamura M, Horita S, Seki G, Moriya K. Bacteremia in hemodialysis patients. World J Nephrol. 2016 Nov;5(6):489-96.
- Soi V, Moore CL, Kumbar L, Yee J. Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies. Int J Nephrol Renovasc Dis. 2016;9:95-103.
- Nguyen DB, Lessa FC, Belflower R, Mu Y, Wise M, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011. Clin Infect Dis. 2013 Nov;57(10):1393-400.
- Palomar Martínez M, Álvarez Lerma F, Riera Badía MA, León Gil C, López Pueyo MJ, Díaz Tobajas C, et al. Prevención de la bacteriemia relacionada con catéteres en UCI mediante una intervención multifactorial. Informe del estudio piloto. Med Intensiva. 2010;34(9):581-9.
- Leonardi G, Finotto G, Talaia M, Nappo A, Dolla C, Di Vico MC, et al. [“Getting to zero infections” in hemodialysis]. G Ital Nefrol. 2015;32(5).
- Collins AJ, Foley RN, Gilbertson DT, Chen S-C. United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int Suppl [Internet]. 2015;5(1):2-7. [Consultado 14 abril 2018]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S2157171615321006.
- Katneni R, Hedayati SS. Central venous catheter-related bacteremia in chronic hemodialysis patients: Epidemiology and evidence-based management. Nat Clin Pract Nephrol. 2007;3(5):256-66.
- Sánchez Villar I. Impacto de frecuencia de urgencias de una unidad extrahospitalaria. Enfermería Nefrológica. 2017;20(1):41.
- Beathard GA, Urbanes A. Infection associated with tunneled hemodialysis catheters. Semin Dial. 2008;21(6):528-38.
- Fram D, Okuno MFP, Taminato M, Ponzio V, Manfredi SR, Grothe C, et al. Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study. BMC Infect Dis. 2015 Mar;15:158.
- Aktas E, Pazarli O, Kulah C, Comert F, Kulah E, Sumbuloglu V. Determination of Staphylococcus aureus carriage in hemodialysis and peritoneal dialysis patients and evaluation of the clonal relationship between carriage and clinical isolates. Am J Infect Control. 2011 Jun;39(5):421-5.
- Barbosa D, Lima L, Silbert S, Sader H, Cendoroglo M, Draibe S, et al. Evaluation of the prevalence and risk factors for colonization by vancomycin-resistant Enterococcus among patients on dialysis. Am J Kidney Dis. 2004 Aug;44(2):337-43.
- Nguyen DB, Shugart A, Lines C, Shah AB, Edwards J, Pollock D, et al. National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. Clin J Am Soc Nephrol. 2017 Jul;12(7):1139-46.
- Sabatier C, Peredo R, Valles J. [Bacterial bloodstream infections in critical patients]. Med intensiva. 2009 Oct;33(7):336-45.
- D’Agata EMC, Mount DB, Thayer V, Schaffner W. Hospital-acquired infections among chronic hemodialysis patients. Am J Kidney Dis [Internet]. 2000 Jun 1;35(6):1083-8. [Consultado 14 abril 2018]. Disponible en: https://doi.org/10.1016/S0272-6386(00)70044-8.
- Schweiger A, Trevino S, Marschall J. Nosocomial infections in dialysis access. Contrib Nephrol [Internet]. 2015;184:205-21. [Consultado el 14 abril 2018]. Disponible en: https://www.karger.com/Article/Pdf/366120.
- Sociedad Española de Medicina Preventiva SP e H. Estudio Epine-Epps 2017. Estud EPiNE. 2017;28:1990-2017.
- Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. J Infect Public Health. 2017 Jul;10(4):403-8.
- Izoard S, Ayzac L, Meynier J, Seghezzi J-C, Jolibois B, Tolani ML. [Infections on catheters in hemodialysis: Temporal fluctuations of the infectious risk]. Nephrol Ther. 2017 Nov;13(6):463-9.
- Coker MA, Black JR, Li Y, Varma R, Almehmi A, Abdel Aal AK, et al. An analysis of potential predictors of tunneled hemodialysis catheter infection or dysfunction. J Vasc Access. 2018 Nov. doi:1129729818809669.
- Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis Tunneled Catheter-Related Infections. Can J kidney Heal Dis. 2016;3:2054358116669129.
- Carrasco Salinas C, Ruiz García M, Gómez López VE, Méndez Ordóñez R, López Andreu M, et al. Análisis de las hospitalizaciones por bacteriemia relacionada con el catéter de hemodiálisis. Enfermería Nefrológica. 2013;16(2):88-92. [Consultado 16 abril 2018]. Disponible en: https://dx.doi.org/10.4321/S2254-28842013000200004.
- Menegueti MG, Betoni NC, Bellissimo-Rodrigues F, Romao EA. Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects. Rev Soc Bras Med Trop. 2017;50(6):783-7.
- Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis tunneled catheter-related infections. Can J Kidney Heal Dis. 2016;3(1).
- Sejia V. Género Staphylococcus. Etiopatogenia microbiológica [Internet]. 2012;III(16):255-72. [Consultado 2 abril 2018]. Disponible en: http://www.higiene.edu.uy/cefa/2008/Staphylococcus.pdf.
- Lata C, Girard L, Parkins M, James MT. Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review. Can J kidney Heal Dis. 2016;3:24.
References
Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al. Guía Clínica Española del Acceso Vascular para Hemodiálisis. Nefrología [Internet]. 2017;37(November):1-193. [Consultado 14 abril 2018]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0211699517302175.
Andreu D, Ángel M, Blanco H. Eventos infecciosos en pacientes en hemodiálisis. 2015;54-6.
Cobo PA, Clave P, Vascular-Catéter:-Bacteriemia-Acceso. Prevalencia de bacteriemias relacionadas con el catéter de hemodiálisis en una unidad hospitalaria. Enferm Nefrol Octubre-Diciembre [Internet]. 2013;16(4):229-34. [Consultado 14 abril 2018]. Disponible en: http://scielo.isciii.es/pdf/enefro/v16n4/original2.pdf.
Ferrer C, Almirante B. Infecciones relacionadas con el uso de los cateteres vasculares. Enferm Infecc Microbiol Clin. 2014;32(2):115-24.
Albalate M, García RP, de Sequera P, Alcázar R, Puerta M, Ortega M, et al. ¿Hemos olvidado lo más importante para prevenir las bacteriemias en pacientes portadores de catéteres para hemodiálisis?. Nefrologia. 2010;30(5):573-7.
Roca-Tey R, Arcos E, Comas J, Cao H, Tort J. Vascular access for incident hemodialysis patients in Catalonia: analysis of data from the Catalan Renal Registry (2000-2011). J Vasc Access. 2015;16(6):472-9.
Gruss E, Portoles J, Caro P, Merino JL, López-Sánchez P, Tato A, et al. Los modelos de atención al acceso vascular condicionan resultados heterogéneos en los centros de una misma comunidad. Nefrologia. 2010;30(3):310-6.
Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2008 Oct;23(10):3219-26.
Zhang HH, Cortes-Penfield NW, Mandayam S, Niu J, Atmar RL, Wu E, et al. Dialysis Catheter-related Bloodstream Infections in Patients Receiving Hemodialysis on an Emergency-only Basis: A Retrospective Cohort Analysis. Clin Infect Dis. 2019 Mar;68(6):1011-6.
Suzuki M, Satoh N, Nakamura M, Horita S, Seki G, Moriya K. Bacteremia in hemodialysis patients. World J Nephrol. 2016 Nov;5(6):489-96.
Soi V, Moore CL, Kumbar L, Yee J. Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies. Int J Nephrol Renovasc Dis. 2016;9:95-103.
Nguyen DB, Lessa FC, Belflower R, Mu Y, Wise M, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011. Clin Infect Dis. 2013 Nov;57(10):1393-400.
Palomar Martínez M, Álvarez Lerma F, Riera Badía MA, León Gil C, López Pueyo MJ, Díaz Tobajas C, et al. Prevención de la bacteriemia relacionada con catéteres en UCI mediante una intervención multifactorial. Informe del estudio piloto. Med Intensiva. 2010;34(9):581-9.
Leonardi G, Finotto G, Talaia M, Nappo A, Dolla C, Di Vico MC, et al. [“Getting to zero infections” in hemodialysis]. G Ital Nefrol. 2015;32(5).
Collins AJ, Foley RN, Gilbertson DT, Chen S-C. United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int Suppl [Internet]. 2015;5(1):2-7. [Consultado 14 abril 2018]. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S2157171615321006.
Katneni R, Hedayati SS. Central venous catheter-related bacteremia in chronic hemodialysis patients: Epidemiology and evidence-based management. Nat Clin Pract Nephrol. 2007;3(5):256-66.
Sánchez Villar I. Impacto de frecuencia de urgencias de una unidad extrahospitalaria. Enfermería Nefrológica. 2017;20(1):41.
Beathard GA, Urbanes A. Infection associated with tunneled hemodialysis catheters. Semin Dial. 2008;21(6):528-38.
Fram D, Okuno MFP, Taminato M, Ponzio V, Manfredi SR, Grothe C, et al. Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study. BMC Infect Dis. 2015 Mar;15:158.
Aktas E, Pazarli O, Kulah C, Comert F, Kulah E, Sumbuloglu V. Determination of Staphylococcus aureus carriage in hemodialysis and peritoneal dialysis patients and evaluation of the clonal relationship between carriage and clinical isolates. Am J Infect Control. 2011 Jun;39(5):421-5.
Barbosa D, Lima L, Silbert S, Sader H, Cendoroglo M, Draibe S, et al. Evaluation of the prevalence and risk factors for colonization by vancomycin-resistant Enterococcus among patients on dialysis. Am J Kidney Dis. 2004 Aug;44(2):337-43.
Nguyen DB, Shugart A, Lines C, Shah AB, Edwards J, Pollock D, et al. National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. Clin J Am Soc Nephrol. 2017 Jul;12(7):1139-46.
Sabatier C, Peredo R, Valles J. [Bacterial bloodstream infections in critical patients]. Med intensiva. 2009 Oct;33(7):336-45.
D’Agata EMC, Mount DB, Thayer V, Schaffner W. Hospital-acquired infections among chronic hemodialysis patients. Am J Kidney Dis [Internet]. 2000 Jun 1;35(6):1083-8. [Consultado 14 abril 2018]. Disponible en: https://doi.org/10.1016/S0272-6386(00)70044-8.
Schweiger A, Trevino S, Marschall J. Nosocomial infections in dialysis access. Contrib Nephrol [Internet]. 2015;184:205-21. [Consultado el 14 abril 2018]. Disponible en: https://www.karger.com/Article/Pdf/366120.
Sociedad Española de Medicina Preventiva SP e H. Estudio Epine-Epps 2017. Estud EPiNE. 2017;28:1990-2017.
Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. J Infect Public Health. 2017 Jul;10(4):403-8.
Izoard S, Ayzac L, Meynier J, Seghezzi J-C, Jolibois B, Tolani ML. [Infections on catheters in hemodialysis: Temporal fluctuations of the infectious risk]. Nephrol Ther. 2017 Nov;13(6):463-9.
Coker MA, Black JR, Li Y, Varma R, Almehmi A, Abdel Aal AK, et al. An analysis of potential predictors of tunneled hemodialysis catheter infection or dysfunction. J Vasc Access. 2018 Nov. doi:1129729818809669.
Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis Tunneled Catheter-Related Infections. Can J kidney Heal Dis. 2016;3:2054358116669129.
Carrasco Salinas C, Ruiz García M, Gómez López VE, Méndez Ordóñez R, López Andreu M, et al. Análisis de las hospitalizaciones por bacteriemia relacionada con el catéter de hemodiálisis. Enfermería Nefrológica. 2013;16(2):88-92. [Consultado 16 abril 2018]. Disponible en: https://dx.doi.org/10.4321/S2254-28842013000200004.
Menegueti MG, Betoni NC, Bellissimo-Rodrigues F, Romao EA. Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects. Rev Soc Bras Med Trop. 2017;50(6):783-7.
Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis tunneled catheter-related infections. Can J Kidney Heal Dis. 2016;3(1).
Sejia V. Género Staphylococcus. Etiopatogenia microbiológica [Internet]. 2012;III(16):255-72. [Consultado 2 abril 2018]. Disponible en: http://www.higiene.edu.uy/cefa/2008/Staphylococcus.pdf.
Lata C, Girard L, Parkins M, James MT. Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review. Can J kidney Heal Dis. 2016;3:24.