Tunneled-cuffed catheter associated infections in hemodialysis patients who are seropositive for the human immunodeficiency virus.
Infection rates in tunneled-cuffed catheters (TCC) are reported to be higher in immunocompromised patients. The purpose of this study was to evaluate TCC-associated infection rates in patients with HIV infection (HIV+). Data were collected in 40 HIV + patients and 41 controls (C), and in 118 TCC (HIV+, 58; C, 60) for 28,146 catheter days (HIV+, 16,227; C, 11,919). There were no significant differences in the TCC bacteremia rates (HIV+, 2.23 versus C, 2.53 per 1000 TCC days, P: = NS) or in the TCC exit site infection rates (HIV+, 2.20 versus C, 2.24 per 1000 TCC days, P: = NS) between the groups. The number of TCC removed due to infection was also similar, (HIV+ versus C: 17 versus 15%, P: = NS). In the HIV+ group, the association of hepatitis B surface antigenemia with TCC exit site infection was dependent on the history of injection drug use. Black race was a significant risk factor for higher TCC exit site infection rates, whereas prophylactic antibiotic use and high CD4 count were significantly associated with lower TCC exit site infection rates. None of the factors significantly predicted bacteremia rate in either group (HIV+ or C). In comparison to controls, HIV+ patients had a fivefold increased risk of having a Gramnegative organism (P: = 0.02) and a sevenfold increased risk of a fungal isolate (P: = 0.08), although the latter finding was not statistically significant. HIV infection is not a significant risk factor for TCC-associated infection but is associated with a higher prevalence of Gram-negative and fungal species.
Mokrzycki
Michele H
MH
Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York.|Departments of Medicine, Jacobi Medical Center, Bronx, New York.|Montefiore Medical Center, Bronx, New York.
Schröppel
Bernd
B
Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York.|Departments of Medicine, Jacobi Medical Center, Bronx, New York.
Gersdorff
Gero VON
GV
Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York.|Departments of Medicine, Jacobi Medical Center, Bronx, New York.
Rush
Heather
H
Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York.|Montefiore Medical Center, Bronx, New York.
Zdunek
Miroslaw P
MP
Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York.|Montefiore Medical Center, Bronx, New York.
Feingold
Robert
R
Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York.|Montefiore Medical Center, Bronx, New York.
D000328:Adult; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology; D002404:Catheterization / Q000009:adverse effects*; D015331:Cohort Studies; D020878:Device Removal / Q000706:statistics & numerical data; D004867:Equipment Design; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D007239:Infections / Q000150:complications* / Q000209:etiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors