A prospective study on incidence of bacterial infections in portuguese dialysis units.
BACKGROUND
Viral infection has been the main epidemiologic concern in the hemodialysis unit; however, bacterial infection is responsible for more than 30% of all causes of morbidity and mortality in our patients, vascular access infection being the culprit in 73% of all bacteremias.


METHODS
A prospective multicenter cohort study of bacterial infections incidence, conducted from January to July 2004 in five hemodialysis units, to record and track bacterial infections, using a validated database from CDC's Dialysis Surveillance Network Program.


RESULTS
4,501 patient-months (P-M) were surveilled, being dialyzed through a native fistula (AVF) in 60.6%, a graft (PTFE) in 31.3%, a tunneled catheter (TC) in 7.6%, and a transient catheter (C) in 0.5%. As target events, we registered 166 hospitalizations - 3.7/100 P-M (2.2/100 P-M in patients with AVF, 4 in PTFE, 9.9 in TC, and 19 in C), and 182 intravenous antibiotic courses. Of these 182 antibiotic treatments, 47.8% included vancomycin, only 30% had blood cultures drawn pretreatment, and only 36% were positive. We recorded 98 infections at the vascular access site 2.18/100 P-M (0.95 in AVF, 1.6 in PTFE, 12.6 in TC, and 42.85 in C) and 2.13 infections/100 P-M at other sites. The isolated microorganisms were Staphylococcus epidermidis in 40.1%, Staphylococcus aureus in 30.1%, Pseudomonas in 13.3%, and Escherichia coli in 3.3%. Although we found a diversity of practice patterns, the number of target events (8.4/100 P-M) and the bacterial infections incidence (4.31/100 P-M) were remarkably homogeneous in the five centers.


CONCLUSIONS
(1) High incidence of bacterial infections, causing major morbidity; (2) infectious risk is vascular access type-dependent, with dramatic rise in catheters; (3) underutilization of blood cultures to orient diagnosis and therapy, and (4) high rates of vancomycin prescription.
Ponce
Pedro
P
Fresenius Medical Care Dialysis Units of Almada, Amadora, Vila Franca, Entroncamento, and Setúbal, and Programa Nacional de Controlo de Infecção, Instituto Ricardo Jorge, Almada, Portugal. pponce@hgo.min-saude.pt
Cruz
João
J
Ferreira
Aníbal
A
Oliveira
Carlos
C
Vinhas
José
J
Silva
Goretti
G
Pina
Elaine
E
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006436:Hemodialysis Units, Hospital; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011174:Portugal / Q000453:epidemiology; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D017678:Sex Distribution