[Surveillance for bacteremia related to vascular access in hemodialysis].
Infections occur frequently in chronic dialysis patients. An incidence study of 13 months' duration (December 2003-January 2004) on nosocomial bacterial infections was performed in a dialysis center (Rivoli Hospital) in the Piedmont region of northern Italy. Data were collected according to a modified CDC methodology (CDC Dialysis Surveillance Network). The total incidence of infections was 4.55/100 patients/month and was lower than that reported for other reference series (CDC 6.16/100 patients/month). The low incidence was associated with a greater use of low-risk vascular access (fistula) than in other countries such as the U.S. The infection rates were: vascular access 1.73% (1.55% local infections, 0.18% access-related bacteremia); 0.82% wound infections; 0.91% pneumonia; 1% urinary tract infections; 0.09% other bacteremias. The hospital utilization rate was 6.9/100 patients/month. Blood cultures were performed in only 28.4% of patients who had received a course of antibiotics. Antibiotics were widely used but the use of vancomycin was less than reported elsewhere (e.g., CDC surveillance). The prevalence of methicillin-resistant Staphylococcus aureus (28 strains isolated) was high (>50%), whereas no vancomycin-resistant enterococci were isolated. Preventing nosocomial bacterial infections in chronic dialysis patients is a top priority; therefore, a surveillance system along the lines of the CDC model should be adopted by all dialysis centers. The risk of nosocomial infection is strongly associated with the type of vascular access.
Ferrero
S
S
Unità Operativa Dialisi, Ospedale di Rivoli, Strada Rivalta 29, Rivoli, Turin, Italy.
Saltarelli
M
M
Quori
A
A
Campobasso
M
M
Argentero
P A
PA
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000628:therapy; D008499:Medical Records; D011159:Population Surveillance; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014573:Urology Department, Hospital