Is systemic heparin a risk factor for catheter-related sepsis in dialysis patients? An evaluation of various biofilm and traditional risk factors.
BACKGROUND
Biofilms are dense aggregates of surface adherent microorganisms embedded in a polysaccharide matrix. Intravenous iron and heparin are thought to promote the formation of biofilm. Both are commonly employed during hemodialysis treatments which might affect the incidence of catheter-related sepsis.


METHODS
559 patients who underwent hemodialysis treatment with a catheter were reviewed. Episodes of sepsis were analyzed for the use of systemic heparin and intravenous iron as well as all other risk factors for sepsis.


RESULTS
Sepsis developed in 141 of the 796 catheters. Analysis of variance revealed that the number of days that the catheter remained in place was the most significant variable (p < 0.0001) associated with catheter-related sepsis along with multiple other variables, but a Cox proportional hazards analysis revealed that only the two biofilm risk factors (intravenous iron [p < 0.001], and mid-treatment bolus of heparin [p = 0.046]) along with previously reported factor of a depressed serum albumin (p = 0.001) are of significance.


CONCLUSIONS
In addition to duration of catheter use, we found three significant risk factors for sepsis and two of those three have been associated with the development of biofilm.
Diskin
Charles J
CJ
Auburn University, Opelika, Ala. 36801, USA. hndt512@bellsouth.net
Stokes
Thomas J
TJ
Dansby
Linda M
LM
Radcliff
Lautrec
L
Carter
Thomas B
TB
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology*; D018441:Biofilms / Q000254:growth & development*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology; D013211:Staphylococcus aureus / Q000502:physiology*
D006493:Heparin