Risk factors associated with sepsis of vascular access in patients undergoing hemodialysis
Abstract
Introduction: Infections are causes of morbidity and mortality in patients with Chronic Renal Disease undergoing hemodialysis.
Objective:To identify the risk factors associated with sepsis of vascular access in patients undergoing hemodialysis.
Material and Methods:Prospective analytical observational study. The sample was composed of all patients who underwent repeated hemodialysis in the service of Ambulatory Hemodialysis with at least three months in the program and no evidences of infection at the beginning of the observation. The variables used were age, sex, time on hemodialysis, cause of chronic renal disease, type of vascular access, type of infection, number of reports, microbiology, hemoglobin, serum albumin, and body mass index. The information was processed automatically. Tests of homogeneity and logistic regression were used.
Results: A total of 102 patients were studied, most of them aged 50 to 69 years, and the male sex predominated in the study. Arterial hypertension and Diabetes Mellitus were the most reported antecedents. Infection was observed in 23 patients, which predominated in those with less than one year of hemodialysis, in its entirety with central venous catheter as a vascular access route. Microbiological isolates corresponded mainly to Staphylococcus aureus. The patients with sepsis presented mean levels of hemoglobin, and lower albumin levels. The risk of sepsis in patients with central venous catheter was significantly higher with regard to the use of arteriovenous fistula.
Conclusions: The use of a central venous catheter for hemodialysis is an independent risk factor for the development of infection in patients undergoing hemodialysis in the Institute of Nephrology.
Keywords: infection, sanitary care, central venous access, catheter for hemodialysis, Staphylococcus aureus, Chronic renal Disease.
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1- Miloševi I, Kora M, Stevanovi G. Nosocomial infections in the Intesive Care Unit, Univerisity Hospital for Infectious and Tropical Diseases, Belgrade, Serbia. Vojnosanit Pregl. 2014; 71(2):131-6
2- Zhou Y, Zhang D, Chen Y, Zhou S, Pan S, Huang Y, et al. Healthcare-Associated Infections and Shanghai Clinicians: A Multicenter Cross-Sectional Study. [Internet]. Aug 2014 Consultado: 2016 Sep 12]; 9(8).Disponible en: http://journals.plos.org/plosone/article/asset?id=10.1371/journal.pone.0105838.pdf
3- Contreras Abad MD, Moreno Delgado MC, Muñoz Benítez I, Herencia Castillejo P, Suanes Cabello L, Crespo Montero R. Duración de los catéteres temporales para hemodiálisis y su relación con las complicaciones. España; 2009[citado 27 oct 2012].p.111113.Disponible en: http://www.revistaseden.org/
4- Mirabet Sáez B, Ferrándiz Martínez MA, García Fornieles T, Sainz Montes MM, Martí i Monros A, Navarro Daudén L, et al. Protocolo enfermero de cuidados de los catéteres venosos tunelizados como acceso vascular para hemodiálisis. Resultados a los 450 días. Enferm Nefrol [Internet]. 2012 [citado 23 ene 2013]; 15 (suppl 1):73. Disponible en: ISSN 028‐9933cielo.isciii.es/pdf/enefro/v15s1/38_comunicacionhemodialisis38.pdf
5- Center for disease control and prevention; Healthcare-associated Infections; HAI Data and Statistics. [Internet]. 2016. Mar Consultado: 2016 Sep 1] Disponible en: http://www.cdc.gov/hai/surveillance/index.html.
6. MINSAP. Programa de Prevención y Control de las Infecciones Asociadas con la Asistencia Sanitaria. Versión 05.2011. Dirección Nacional de Epidemiología. La Habana: MINSAP. 2011.
7- Andreu Périz D., et al. Arroyo Eventos infecciosos en pacientes en hemodiálisis. Enferm Nefrol 2015: Enero-Marzo; 18 (1): 54-56
8- Gil JM, Marron B. La realidad y la percepción de las infecciones en diálisis, Revista Nefrológica, servicio de nefrología Complejo Hospitalario de Jaén España, 2010.
9- Hernández J; Garcia H; Torregrosa E. et.al Seguimiento a largo plazo de catéteres permanentes en pacientes con dificultad en la obtención de un acceso vascular definitivo Servicio de Nefrología. Hospital General de Castellón. Centro de Diálisis Gambro HealthCare, Centro de Diálisis Nefrovall. 2004.
10- Klevens RM, Tokars JJ, Andrus M. Electronic reporting of infections associated with hemodialysis Nephrology News & Issues June 2005 37-43. Disponible en:http://www.cdc.gov/nhsn/PDFs/data Stat/2006.
11- Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, Wolfe RA, Goodkin DA, Held PJ.Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 2002; 61:305–316.
12- Sandeep S. Soman, Jerry Yee, Kevin Ho. Quality Improvement Initiatives in Kidney Disease. cap 87. p 2620-36. The Kidney. Brenner and Rector’s Edition 10. 2016
13- Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004; 39:309–17.
14- Coello R, Charlett A, Ward V, Wilson J, Pearson A, Sedgwick J, et al. Device related sources of bacteraemia in English hospitals —opportunities for the prevention of hospital-acquired bacteraemia. J Hosp Infect. 2003; 53:46–57.
15- Rodríguez-Ba˜no J, López-Prieto MD, Portillo MM, Retamar P, Natera C, Nu˜no E, et al. Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect. 2010; 16:1408–13.
16- Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007; 7:645–57
17- Ratnaja K, Susan H. Central venous catéter-related bacteiremia in chronic hemodialisis patients: epidemiology an evidence-based management. Nat Rev Nephrol 2007; 3:256-66
18- Ghonemy T, Farag S, Soliman S, Amin E, Zidan A. Vascular access complications and risk factors in hemodialysis patients: A single center study. Alexandria Journal of Medicine (2016) 52, 67-71
19- Martínez Allo P., Fuchila I, Migliavacca F., Nicolini ME, Pintos A, Levy F. Neumonía cavitada en infeccion por Staphilococcus aureus asociada a cateter de hemodiálisis. Nefrología, Diálisis y Trasplante 2016; 36 (1) Pág. 65-66
20- Mokrzycki MH, Zhang M, Cohen H, Golestaneh L, Laut JM, Rosenberg SO. Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant 2006; 21(4):1024-31.
21- Sociedad Española de Nefrología. Guías de acceso vascular en hemodiálisis [Internet].España; 2004 [citado20 octubre 2012].p.1178. Disponible en: http://www.revistaseden.org/files/rev48_1.pdf
22- Rodríguez Hernández JA, Gutiérrez Julián JM. Acceso vascular en hemodiálisis. Sociedad Española de Nefrología [Internet]. 2013[citado 23 ene 2013]; 5: 116-141. Disponible en: http://www.senefro.org/modules/webstructure/Files/guía–accesovascular. pdf
23- Ferrer C. y Almirante B. Infecciones relacionadas con el uso de los catéteres vasculares. Enferm Infecc Microbiol Clin. 2014; 32(2):115–124
24- Riu M., Terradas R., Sala M., Comas M., Knobel H., Grau S. y Cots. F. Costes asociados a las bacteriemias nosocomiales en un hospital universitario. Enfermedades infecciosas y microbiología clínica. 2012; 30:137–142.
25- Raad I., Hanna H., y Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007 Oct; 7(10):645-57.
26- Esposito S., Purrello S.M., Bonnet E., Novelli A., Tripodi F., Pascale R., Unal S., y Milkovich G. Central venous catheter-related biofilm infections: An up-to-date focus on meticillin-resistant Staphylococcus aureus. Journal of global antimicrobial resistance, ISSN: 2213-7173, Vol: 1, Issue: 2, Page: 71-78
27- Infección asociada a catéter en hemodiálisis: diagnóstico, tratamiento y prevención A. Aguinaga1, J.L. del Pozo2 NefroPlus 2011;4(2):1-10 doi:10.3265/NefroPlus.pre2011.Jun.11016
28- Katneni R, Hedayati SS. Central venous catheter-related bacteremia in chronic hemodialysis patients: epidemiology and evidence-based management. Nat Clin Pract Nephrol. 2007 May;3(5):256-66. Review
29- Vega de la Torre1 MV, de la Torre Rosés MV, Diéguez Velásquez D., Nicó García M, Valenciano García Y. Infecciones relacionadas con el acceso vascular en pacientes con insuficiencia renal crónica terminal en hemodiálisis Rev Inf Cient. 2015; 90(2):239-251 ISSN 1028-9933
30- Del Pozo JL, Aguinaga A. Infección asociada a catéter en hemodiálisis: diagnóstico, tratamiento y prevención. NefroPlus 2011;4(2):1-10 | doi: 10.3265/NefroPlus.pre2011.Jun.11016
31- Roca Tey R. El acceso vascular para hemodiálisis: la asignatura pendiente. Rev. Nefrología [Internet].2010 [citado 27 octubre 2012]; 30(3):280-7. Disponible en: http://scielo.isciii.es/pdf/nefrologia/v30n3/comentario_editorial2.pdf
32- Crespo Montero R, Contreras Abad MD, Casas Cuesta R, Muñoz Benítez I, Moreno Delgado MC, Suanes Cabello L. Estudio retrospectivo de las complicaciones de los catéteres temporales para hemodiálisis. Rev Soc Esp Enferm Nefrol [Internet].2012 [citado 23 ene 2013]; 41(1):43-49. Disponible en: http://scielo.isciii.es/pdf/nefro/v14n1/original6.pdf
33- Tulleuda Lari ML, Galceran Gui JM, Casals Suau G, Gassó Bonvehi D, Mas RubioD, Obradors Soriano D, et al. Catéteres centrales para hemodiálisis. Rev. Soc Esp Enferm Nefrol [Internet].2012 [citado 23 ene 2013]; 67(2)54-61. Disponible en: http://www.revistaseden.org/files/2048_67%5B2%5D.pdf 12
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