Division of Nephrology, University of Alabamaat Birmingham, Birmingham, AL 35294, USA.
Clin J Am Soc Nephrol. 2011 Sep;6(9):2247-52. doi: 10.2215/CJN.03900411. Epub 2011 Jul 7.
Catheter-dependent hemodialysis patients may develop access-related and nonaccess-related infections that may be managed in the outpatient arena or in the hospital. The goal of this study was to quantify infections in such patients, to characterize their clinical presentations, and to evaluate factors determining need for hospitalization.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We collected prospective data on the clinical management of catheter-dependent hemodialysis patients with suspected infection at a large dialysis center. We documented the presenting symptoms, type of infection, pathogen, and whether hospitalization occurred.
An infection was suspected in 305 separate cases and confirmed in 88%. The 268 diagnosed infections included catheter-related bacteremia (69%), another access-related infection (19%), and nonaccess-related infection (12%). The overall frequency of infection was 4.62 per 1000 catheter-days. Hospitalization occurred in 37% of all infections, but it varied greatly (72% for nonaccess-related infection, 34% for catheter-related bacteremia, and 4% for exit-site infection). Among patients with catheter-related bacteremia, the likelihood of hospitalization varied by pathogen, being 53% for Staphylococcus aureus, 30% for Enterococcus, 23% for Staphylococcus epidermidis, and 17% for gram-negative rods (P < 0.001). The likelihood of hospitalization was not associated with age, gender, or diabetes. Fever was a presenting symptom in only 47% of cases of catheter-related bacteremia.
Catheter-dependent patients have a high burden of infection. It is important to evaluate patients with suspected infection for various access-related and nonaccess-related infections. A low threshold is indicated for suspecting catheter-related bacteremia because the patients frequently present without fever.
依赖导管的血液透析患者可能会发生与通路相关或不相关的感染，这些感染可能在门诊或医院得到治疗。本研究的目的是量化此类患者的感染情况，描述其临床表现，并评估决定住院治疗的因素。
设计、地点、参与者和测量：我们在一家大型透析中心收集了疑似感染的依赖导管血液透析患者的临床管理的前瞻性数据。我们记录了患者的临床表现、感染类型、病原体以及是否住院。
305 例疑似感染的患者中，88%确诊。268 例确诊的感染中，导管相关性菌血症（69%）、另一种与通路相关的感染（19%）和非与通路相关的感染（12%）。总的感染发生率为每 1000 个导管日 4.62 例。所有感染中，37%的患者需要住院治疗，但差异很大（非与通路相关的感染为 72%，导管相关性菌血症为 34%，出口部位感染为 4%）。在导管相关性菌血症患者中，住院治疗的可能性因病原体而异，金黄色葡萄球菌为 53%，肠球菌为 30%，表皮葡萄球菌为 23%，革兰氏阴性杆菌为 17%（P<0.001）。住院治疗的可能性与年龄、性别或糖尿病无关。只有 47%的导管相关性菌血症患者出现发热的临床表现。
依赖导管的患者感染负担较高。评估疑似感染的患者时，需要考虑各种与通路相关和不相关的感染。对于疑似导管相关性菌血症的患者，应保持较低的怀疑阈值，因为这些患者常无发热表现。
