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논문 기본 정보

자료유형
학술저널
저자정보
저널정보
대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제43권 제4호
발행연도
2011.1
수록면
343 - 348 (6page)

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Background: Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients. Materials and Methods: Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access. Results: Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28(12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%)had a temporary central catheter. The mean±SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6±36.9 days, tunneled cuffed catheter 180.3±168.8 days, AV fistulas 928.6±1,299.7 days, and AV graft 1,066.3±1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%;methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%),tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12,33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%. Conclusions: Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.
#Catheter-related infections #Hemodialysis

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Bone RC / 1992 / Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American google schola Cook RJ / 2005 / Septic pulmonary embolism: presenting features and clinical course of 14 patients / Chest 128 : 162 ~ 166 google schola Danese MD / 2006 / Mortality differences among organisms causing septicemia in hemodialysis patients / Hemodial Int 10 : 56 ~ 62 google schola Dhingra RK / 2001 / Type of vascular access and mortality in U.S. hemodialysis patients / Kidney Int 60 : 1443 ~ 1451 google schola ESRD Registry Committee / 2010 / Current renal replacement therapy in Korea: Insan memorial dialysis registry, 2009 / Korean J Nephrol 29 (2) : S525 ~ S551 google schola

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