Clinical considerations in hemodialysis access infection.
Hemoaccess infections remain a substantial cause of morbidity in patients on hemodialysis, especially with the increasing reliance on prosthetic devices as the average age of the hemodialysis population increases. Access manipulation, either through needle puncture or secondary surgical procedures, is the primary etiology of infection. Other conditions such as access location, patient hygiene, and intravenous drug use can cause contamination. Local evidence of inflammation or infection, especially pain and purulence, are the most reliable signs of infection; however, the access can be infected and there may be minimal systemic symptoms. Medical therapy must be directed primarily against Staphylococcus aureus, with vancomycin being used most frequently. There are distinct conditions in which infection with gram-negative bacilli is also common. A coordinated effort between medical management and surgical intervention is essential to optimize therapy. Several situations, such as loss of vascular integrity or infection at anastomosis sites, mandate full excision of the graft. However, the access or at least the access site, can be preserved through creative surgical intervention along with aggressive medical treatment. Approaches to the diagnosis and treatment of infection in autologous arteriovenous fistulae, polytetrafluoroethylene arteriovenous conduits, and cuffed dual-lumen venous hemodialysis catheters are discussed.
Albers
F J
FJ
Department of Medicine, Duke University, Durham, NC., USA.
D002406:Catheterization, Peripheral; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology* / Q000628:therapy