Infection of arterio-venous fistulas created for chronic haemodialysis.
One of the complications of chronic haemodialysis is infection at the venous access site. A retrospective chart review (1985-1990) was done on patients requiring venoaccess for haemodialysis. 197 patients had 254 arterio-venous (A-V) fistulas created. 40 patients had 71 prosthetic implants and 157 patients had 183 autogenous fistulas created. 16 (22%) prosthetic grafts were infected versus 8 (4.3%) autogenous fistulas (p < 0.0001). Bacteraemia was present in 9/16 (56%) infected prosthetic grafts and 4/8 (50%) infected autogenous fistulas. Seven (43.8%) of the prosthetic grafts required removal; 6 (37.5%) were cured with drainage, irrigation and antibiotics, and 3 (18.8%) with antibiotics alone. One (12.5%) of the autogenous fistulas was removed, 4 (50%) required revision and 3 (37.5%) were treated with antibiotics alone. Whenever possible, A-V fistulas should be created in the arms with an autogenous graft as infections are less and easier to treat.
Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
I W
IW
Fong
J M
JM
Capellan
M
M
Simbul
J
J
Angel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016470:Bacteremia / Q000453:epidemiology; D004322:Drainage; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000628:therapy; D006435:Renal Dialysis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000628:therapy; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors
D000900:Anti-Bacterial Agents