Bloodstream infection at hemodialysis facilities in Jeddah: a medical record review.

BACKGROUND

Bloodstream infections (BSI) are a major complication of hemodialysis. The risk of infection among hemodialysis patients is usually associated with the dialysis procedure itself, specifically the means of vascular access.

OBJECTIVES

Estimate the rate of BSI and assess factors possibly associated with BSI.

DESIGN

Analytical retrospective medical record review.

SETTING

Hemodialysis unit in a tertiary care center.

PATIENTS AND METHODS

Adult patients (18-60 years old) who had hemodialysis as first renal replacement therapy in the 20-month period from January 2014 to August 2016 were included in this study. Demographic and clinical characteristics were used in a multivariate logistic regression to assess factors that might be associated with BSI.

MAIN OUTCOME MEASURES

The rate of BSI and associated factors among chronic hemodialysis outpatients.

SAMPLE SIZE AND CHARACTERISTICS

160 outpatients on hemodialysis, median (IQR) age 47.7 (37.0-56.0) years, males (60.6%).

RESULTS

The rate of BSI was 0.4 per 100 patient-months. Multivariate logistic regression revealed that patients who had central venous catheters had the highest risk for BSI (odds ratio: 10.088; 95% CI= 2.595-39.215; P=.001) compared with arteriovenous fistulas. Gram-negative bacteria were isolated in 54.6% of cases, with coagulase-negative Staphylococcus the most frequent isolate (18.2%), followed by Klebsiella pneumoniae and Enterobacteriaceae (15.2%, each).

CONCLUSIONS

The type of vascular access type is the main risk factor associated with BSI in hemodialysis patients. The arteriovenous fistula, which has a lower infection rate compared to the catheter, is the best available option for hemodialysis patients.

LIMITATIONS

Retrospective, single center and relatively small sample size.

CONFLICT OF INTEREST

None.