Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202200981
Jornal Vascular Brasileiro
Original Article

Fatores preditivos de infecção em pacientes renais crônicos em uso de cateteres venosos centrais

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Contexto: Infecção é a complicação mais frequente do uso de cateter venoso central em hemodiálise.

Objetivo: O propósito do trabalho foi determinar a taxa de incidência de infecções de cateteres venosos centrais para hemodiálise em um centro de diálise no estado do Amazonas, bem como seus fatores preditivos, além de traçar o perfil microbiológico dessas infecções.

Métodos: Trata-se de um estudo observacional, com dados coletados mensalmente e de forma prospectiva, por meio de entrevista e análise de prontuários de pacientes submetidos a hemodiálise por meio de cateteres venosos centrais em um centro de diálise durante um período de 12 meses.

Resultados: Foram analisados 96 cateteres venosos centrais, de 48 pacientes. Do total, foram 78 cateteres venosos não tunelizados (81,3%) e 18 cateteres venosos tunelizados (18,7%). Dos cateteres acompanhados, 53,1% foram trocados por motivo de infecção, sendo realizada hemocultura de 35,2% dos pacientes que apresentaram infecção de cateter. Quanto ao perfil microbiológico, das nove hemoculturas positivas, em cinco foram isoladas bactérias gram-negativas, e em quatro foram isoladas bactérias gram-positivas. A bactéria mais frequentemente isolada foi a Staphylococcus hominis, presente em 22,2% das hemoculturas positivas.

Conclusão: A taxa de incidência global de infecção de cateteres venosos centrais foi de 10,1 episódios por 1.000 dias de cateter, sendo de 15,1 nos cateteres não tunelizados e de 3,3 nos cateteres tunelizados. Os fatores preditivos identificados foram o uso de cateter venoso central não tunelizado e a realização de duas sessões de diálise semanais. Quanto ao perfil microbiológico, pouco mais da metade das bactérias isoladas foram gram-negativas.
diálise renal, unidades hospitalares de hemodiálise, infecções relacionadas a cateter, cateteres de demora

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.

renal dialysis; hemodialysis units, hospital; catheter-related infections; central venous catheters

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Submitted date:
07/20/2022

Accepted date:
05/09/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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