School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil.
Infection Control Unit, Children's Institute and Institute for the Treatment of Childhood Cancer, School of Medicine, Universidade de São Paulo (University of São Paulo - ITACI/FMUSP), Av. Dr. Enéas Carvalho de Aguiar 647, São Paulo, 05403-000, Brazil.
BMC Infect Dis. 2015 Mar 26;15:158. doi: 10.1186/s12879-015-0907-y.
Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.
Risk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case-control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.
There were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17-24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9-23.09).
Infection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.
感染是接受肾脏替代治疗患者发病率的主要原因，也是死亡率的第二大原因。血液透析患者血流感染的发生率因所使用的静脉通路类型而异。革兰氏阳性菌是血液透析患者血培养中最常分离出的细菌。本研究评估了血液透析患者血流感染发展的相关危险因素。
采用病例对照研究，对 2010 年 1 月至 2013 年 6 月期间接受血液透析的患者发生血流感染的危险因素进行了调查。研究期间血培养阳性的慢性肾脏疾病血液透析患者被视为病例，同期同一机构血培养未阳性的血液透析患者被视为对照。数据来自病历。采用逻辑回归进行统计分析。
本研究共纳入 162 例患者（81 例病例和 81 例对照）。革兰氏阳性菌的分离率最高（72%）。在初始逻辑回归分析中，变量包括高血压、有既往治疗史的腹膜透析、当前静脉通路的类型和时间、既往静脉通路的类型、既往使用抗菌药物以及与血流感染相关的既往住院治疗。多因素回归分析显示，与动静脉内瘘血管通路患者相比，中心静脉导管患者发生血流感染的几率增加 11.2 倍（95%CI：5.17-24.29）。既往住院治疗使发生血流感染的几率增加 6.6 倍（95%CI：1.9-23.09）。
应加强与中心静脉导管使用相关的血流感染预防措施，并且在进行血液透析时明智地选择该途径作为血管通路。通过减少住院暴露，可能有助于降低该人群的血流感染率。
