title: Catheter-related infections in chronic hemodialysis: a clinical and economic perspective.
abstract: OBJECTIVE
  Central venous catheters emerged as a major risk factor for infectious complications in hemodialysis (HD) patients. We aimed to assess the incidence of bacteremia in catheter-dependent HD patients and to characterize its clinical and economic impact.
  
  
  METHODS
  We retrospectively collected clinical data and healthcare costs from 15 months for 75 admitted catheter-dependent HD patients, to document the type of bacteremia (complicated or not), pathogen and inflammation.
  
  
  RESULTS
  Bacteremia (97 % with Staphylococcus aureus, 33 % methicillin-resistant) was present in 51 % patients, with an overall infections incidence of 5.79 per 1,000 catheter-days. Metastatic complications occurred in 21 % of bacteremic patients and were associated with higher mortality (38 vs. 4 %; p = 0.001). Although, in patients starting dialysis on catheter (41 %) as compared to those using catheter as bridge angioaccess, inflammation (higher C-reactive protein; p = 0.006) and anemia (lower Hb; p = 0.008) were more pronounced, bacteremia occurred in a lower proportion (32 vs. 64 %, p = 0.007). The total medical costs were 47 % higher in patients with complicated bacteremia than in those without bacteremia (p = 0.008) and 45 % higher in patients starting HD on catheter than in those using catheter as bridge angioaccess (p = 0.002).
  
  
  CONCLUSIONS
  Despite the limitations resulting from retrospective cross-sectional single-center design, our study suggests that patients already on HD who required catheters as bridge angioaccess were more prone to bacteremia. This highlights the importance of close angioaccess monitoring to avoid unnecessary catheter usage. A similar increase in costs when initiating dialysis on catheter as in case of complicated bacteremia strongly supports the initial placement of a native arteriovenous fistula.
authors: Department of Nephrology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. gabriel_stefan@rocketmail.com
authors: Gabriel
authors: G
authors: Ştefan
authors: Simona
authors: S
authors: Stancu
authors: Cristina
authors: C
authors: Căpuşă
authors: Oana Ramaiana
authors: OR
authors: Ailioaie
authors: Gabriel
authors: G
authors: Mircescu
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics* / Q000295:instrumentation; D012189:Retrospective Studies; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*