title: Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis.
abstract: OBJECTIVE
  Infection is a common cause of death among hemodialysis patients. The study investigated incidence, risk factors, clinical features and outcome of bloodstream infections (BSIs) in haemodialysis patients.
  
  
  METHODS
  The records of haemodialysis patients from 1999 to 2005 were reviewed. Risk factors were investigated by multivariate analysis.
  
  
  RESULTS
  There were identified 148 bacteremic episodes, in 102 patients. The BSI rate was 0.52 per 1000 patient-days. Of the 148 episodes, 34 occurred in patients with permanent fistulae (0.18/1000 patient-days); 19 in patients with grafts (0.39/1000 patient-days); 28 in patients with permanent tunneled central catheters (1.03/1000 patient-days); and 67 in those with temporary-catheter (3.18/1000 patient-days). With fistula as reference, the BSI ratio was 1.84 with arteriovenous graft (P=.029), 4.85 with permanent central venous catheter (P<.001), and 14.88 with temporary catheter (P <.001). Catheter related were 41 episodes (28%). Gram positive organism were responsible for 96 episodes (65%), with S. aureus ( 55%) the most frequent, followed by S. epidermidis (26%) and Gram-negative for 36 (23%), with E. coli (39%) the most frequent. Infection was polymicrobial in 14 (9.5%). Diabetes (p<0.001), low serum albumin (p=0.040) and low hemoglobin (p<0.001) were significant risk factors. During hospitalization 18 patients (18%) died. Septic shock (p<0.001) and polymicrobial infection (p=0.041) were associated with in-hospital mortality.
  
  
  CONCLUSIONS
  The risk of BSI in patients undergoing hemodialysis is related to the catheter type and vascular access. Septic shock and polymicrobial infection predispose to unfavourable outcome.
authors.affiliation: 2. Department of Nephrology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Fysaraki
authors.forename: George
authors.initials: G
authors.lastname: Samonis
authors.forename: Antonis
authors.initials: A
authors.lastname: Valachis
authors.forename: Eugenios
authors.initials: E
authors.lastname: Daphnis
authors.forename: Drosos E
authors.initials: DE
authors.lastname: Karageorgopoulos
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
authors.forename: Kostas
authors.initials: K
authors.lastname: Stylianou
authors.forename: Diamantis P
authors.initials: DP
authors.lastname: Kofteridis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D055499:Catheter-Related Infections / Q000097:blood / Q000196:embryology* / Q000382:microbiology* / Q000473:pathology; D004926:Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity
keywords: Antimicrobial Resistance; Epidemiology; Sepsis; Vascular Catheter-Related Infections