Fatores preditivos de infecção em pacientes renais crônicos em uso de cateteres venosos centrais
Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters
Juliana da Costa Matos; Laura Lane Menezes Polsin; Karla Cristina Petrucelli Israel; Leonardo Pessoa Cavalcante
Resumo
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Abstract
Background: Infection is the most frequent complication of central venous catheters used for hemodialysis.
Objectives: The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections.
Methods: This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center.
Results: 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures.
Conclusion: The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.
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References
1 Rayner HC, Pisoni RL. The increasing use of hemodialysis catheters: evidence from the DOPPS on its significance and ways to reverse it. Semin Dial. 2010;23(1):6-10.
2 Hoen B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998;9(5):869-76.
3 Astor BC, Eustace JA, Powe NR, et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. J Am Soc Nephrol. 2005;16(5):1449-55.
4 O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-93.
5 Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45.
6 Alhazmi SM, Noor SO, Alshamrani MM, Farahat FM. Bloodstream infection at hemodialysis facilities in Jeddah: a medical record review. Ann Saudi Med. 2019;39(4):258-64.
7 Lafrance JP, Rahme E, Lelorier J, Iqbal S. Vascular access-related infections: definitions, incidence rates, and risk factors. Am J Kidney Dis. 2008;52(5):982-93.
8 Abramson JH. WINPEPI updated: computer programs for epidemiologists, and their teaching potential. Epidemiol Perspect Innov. 2011;8(1):1.
9 Fram D, Okuno MF, Taminato M, et al. Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study. BMC Infect Dis. 2015;15(1):158.
10 Gauna TT, Oshiro E, Luzio YC, Paniago AM, Pontes ER, Chang MR. Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil. Rev Soc Bras Med Trop. 2013;46(4):426-32.
11 Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4, Suppl 2):S1-164.
12 Ling CL, Roberts T, Soeng S, et al. Impact of delays to incubation and storage temperature on blood culture results: a multi-centre study. BMC Infect Dis. 2021;21(1):173.
13 Araujo MRE. Hemocultura: recomendações de coleta, processamento e interpretação dos resultados. J Infect Control. 2012;1(1):8-19.
14 Levinson W. Diagnóstico laboratorial. In: Levinson W. Microbiologia médica e imunologia. 10. ed. Porto Alegre: ArtMed; 2010. Cap. 9, p. 71-163.
15 Palmer HR, Palavecino EL, Johnson JW, Ohl CA, Williamson JC. Clinical and microbiological implications of time-to-positivity of blood cultures in patients with Gram-negative bacilli bacteremia. Eur J Clin Microbiol Infect Dis. 2013;32(7):955-9.
16 Melo GB, Melo MC, Carvalho KS, Gontijo PP Fo.
17 Esmanhoto CG, Taminato M, Fram DS, Belasco AGS, Barbosa DA. Microrganismos isolados de pacientes em hemodiálise por cateter venoso central e evolução clínica relacionada. Acta Paul Enferm. 2013;26(5):413-20.
18 Brasil. Boletim de Segurança do Paciente e Qualidade em Serviços de Saúde no 14: Avaliação dos indicadores nacionais das Infecções Relacionadas à Assistência à Saúde (IRAS) e Resistência microbiana do ano de 2015. Brasília: ANVISA; 2016.
19 Taylor G, Gravel D, Johnston L, et al. Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units. Infect Control Hosp Epidemiol. 2002;23(12):716-20.
20 Wolfe RA, Ashby VB, Daugirdas JT, Agodoa LY, Jones CA, Port FK. Body size, dose of hemodialysis, and mortality. Am J Kidney Dis. 2000;35(1):80-8.
21 Port FK, Ashby VB, Dhingra RK, Roys EC, Wolfe RA. Dialysis dose and body mass index are strongly associated with survival in hemodialysis patients. J Am Soc Nephrol. 2002;13(4):1061-6.
22 Allon M, Depner TA, Radeva M, et al. Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO study. J Am Soc Nephrol. 2003;14(7):1863-70.
23 Bevilacqua JL, Gomes JG, Santos VF, Canziani ME. Comparison of trisodium citrate and heparin as catheter-locking solution in hemodialysis patients. J Bras Nefrol. 2011;33(1):86-92.
24 Neves PDMM, Sesso RCC, Thomé FS, Lugon JR, Nasicmento MM. Brazilian Dialysis Census: analysis of data from the 2009-2018 decade. J Bras Nefrol. 2020;42(2):191-200.
Submitted date:
07/20/2022
Accepted date:
05/09/2023
