title: Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study.
abstract: BACKGROUND
  Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.
  
  
  METHODS
  Risk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case-control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.
  
  
  RESULTS
  There were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17-24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9-23.09).
  
  
  CONCLUSIONS
  Infection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.
authors: School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil. dayana.fram@unifesp.br.
authors: Dayana
authors: D
authors: Fram
authors: School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil. mf.pinto@unifesp.br.
authors: Meiry Fernanda Pinto
authors: MF
authors: Okuno
authors: School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil. mo_tami@yahoo.com.br.|Infection Control Unit, Children's Institute and Institute for the Treatment of Childhood Cancer, School of Medicine, Universidade de São Paulo (University of São Paulo - ITACI/FMUSP), Av. Dr. Enéas Carvalho de Aguiar 647, São Paulo, 05403-000, Brazil. mo_tami@yahoo.com.br.
authors: Mônica
authors: M
authors: Taminato
authors: Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo (Paulista School of Medicine, Federal University of São Paulo - EPM/UNIFESP), R. Napoleão de Barros, 715, 7° andar, São Paulo, 04024-002, Brazil. viponzio@gmail.com.
authors: Vinicius
authors: V
authors: Ponzio
authors: Division of Dialysis, Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, (Kidney and Hypertension Hospital, Foundation Oswaldo Ramos - HRIM/FOR), R. Pedro de Toledo 282, São Paulo, 04039-030, Brazil. silmanf@yahoo.com.br.
authors: Silvia Regina
authors: SR
authors: Manfredi
authors: School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil. cibelegrothe@hotmail.com.
authors: Cibele
authors: C
authors: Grothe
authors: School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil. abelasco@unifesp.br.
authors: Angélica
authors: A
authors: Belasco
authors: Division of Nephrology, Paulista School of Medicine, Universidade Federal de São Paulo (Federal University of São Paulo - EPM/UNIFESP), R. Botucatu 740, São Paulo, 04023-900, Brazil. rsesso@unifesp.br.
authors: Ricardo
authors: R
authors: Sesso
authors: School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil. dulce.barbosa@unifesp.br.
authors: Dulce
authors: D
authors: Barbosa
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D016470:Bacteremia / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D062905:Central Venous Catheters / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus