Risk factors for yeast superinfection in the treatment of suspected exit site infections: a case-control study.
OBJECTIVE
The risk of infection can be reduced in hemodialysis (HD) patients with central venous catheters (CVCs) by using prophylactic intranasal mupirocin or polysporin at the exit site. However, there are concerns about the potential emergence of resistant microorganisms. The purpose of our study was to determine if the use of polysporin double in the treatment of exit site infections was associated with the emergence of yeast positive exit site cultures.


METHODS
In this case control study, we evaluated the risk of developing yeast positive exit site cultures after introducing a polysporin medical directive for the treatment of presumed exit site infections in our HD units. All HD patients using a CVC for blood access at the Ottawa Hospital were eligible for study. Demographic variables, use of polysporin, antibiotics and immunosuppressive medications were compared between those patients with yeast positive exit site cultures and controls.


RESULTS
There was no differences in age, gender or diabetic status between the cases and controls. However, the use of polysporin, antibiotics and immunocompromised status were associated with an increased risk of yeast positive exit site cultures. The relative importance of each of these factors could not be determined using this study design and requires future prospective study.


CONCLUSIONS
The emergence of yeast positive exit site cultures after the introduction of a new medical directive at a tertiary care hospital highlights the difference between medications used for prophylaxis and those used for treatment of CVC infections in high risk dialysis patients.
Oliveira
L
L
Department of Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada.
Graham
J
J
Lok
C
C
MacFarlane
S
S
Zimmerman
D
D
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001414:Bacitracin / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D015163:Superinfection / Q000188:drug therapy / Q000209:etiology*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome; D015003:Yeasts / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; C069612:bacitracin, polymyxin B drug combination; D001414:Bacitracin; D011112:Polymyxin B