title: Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil.
abstract: BACKGROUND
  Vascular access in patients undergoing hemodialysis is considered a critical determinant of bloodstream infection (BSI) and is associated with high morbidity and mortality. The purpose of this study was to investigate the occurrence of BSI in patients with end-stage renal disease using central venous catheters for hemodialysis.
  
  
  METHODS
  A cohort study was conducted in a public teaching hospital in central-western Brazil from April 2010 to December 2011. For every patient, we noted the presence of hyperemia/exudation upon catheter insertion, as well as fever, shivering, and chills during hemodialysis.
  
  
  RESULTS
  Fifty-nine patients were evaluated. Thirty-fi ve (59.3%) patients started dialysis due to urgency, 37 (62.7%) had BSI, and 12 (20%) died. Hyperemia at the catheter insertion site (64.9%) was a significant clinical manifestation in patients with BSI. Statistical analysis revealed 1.7 times more cases of BSI in patients with hypoalbuminemia compared with patients with normal albumin levels. The principal infective agents identified in blood cultures and catheter-tip cultures were Staphylococcus species (24 cases), non-fermentative Gram-negative bacilli (7 cases of Stenotrophomonas maltophilia and 5 cases of Chryseobacterium indologenes), and Candida species (6). Among the Staphylococci identified, 77.7% were methicillin-resistant, coagulase-negative Staphylococci. Of the bacteria isolated, the most resistant were Chryseobacterium indologenes and Acinetobacter baumannii.
  
  
  CONCLUSIONS
  Blood culture was demonstrated to be an important diagnostic test and identified over 50% of positive BSI cases. The high frequency of BSI and the isolation of multiresistant bacteria were disturbing findings. Staphylococcus aureus was the most frequently isolated microorganism, although Gram-negative bacteria predominated overall. These results highlight the importance of infection prevention and control measures in dialysis units.
authors: Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Groso do Sul, Campo Grande, MS. tamaratrelha@ig.com.br
authors: Tamara Trelha
authors: TT
authors: Gauna
authors: Elizete
authors: E
authors: Oshiro
authors: Yuri Correa
authors: YC
authors: Luzio
authors: Anamaria Mello Miranda
authors: AM
authors: Paniago
authors: Elenir Rose Jardim Cury
authors: ER
authors: Pontes
authors: Marilene Rodrigues
authors: MR
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology*; D055499:Catheter-Related Infections / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D016469:Fungemia / Q000382:microbiology*; D006784:Hospitals, Teaching; D006801:Humans; D007676:Kidney Failure, Chronic / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors