title: Gram-negative bacteraemia in haemodialysis.
abstract: BACKGROUND
  Patients on renal replacement therapy experience higher rates of morbidity and mortality, infection being the second commonest cause of death. In our haemodialysis population, we identify the pathogens, sensitivity patterns, sources of infection and outcomes of Gram-negative bacteraemia.
  
  
  METHODS
  Data from the NHS Greater Glasgow & Clyde and NHS Forth Valley haemodialysis population were collected July 2011 to April 2014 through an interrogation of the renal unit electronic patient record, and confirmed by an independent search of the Microbiology database.
  
  
  RESULTS
  Over 544 377 haemodialysis days, 84 patients experienced 95 Gram-negative bacteraemia events, a rate of 0.175 events per 1000 haemodialysis days, which varied with dialysis modality: non-tunnelled central venous catheters 4.77, arteriovenous grafts 0.24, tunnelled central venous catheters 0.21, and arteriovenous fistulae 0.11 per 1000 haemodialysis days. The commonest sources of bacteraemia were central venous catheters (CVCs) (16.8%, n = 16), infected ulcers (14.7%, n = 14), urinary (10.5%, n = 10), biliary (9.5%, n = 9) and intra-abdominal (9.5%, n = 9).The principal organisms were Escherichia coli (49.5%, n = 47), Enterobacter spp. (13.1%, n = 13), Klebsiella spp. (11.1%, n = 11), Proteus mirabilis (6.1%, n = 6) and Pseudomonas aeruginosa (5.1%, n = 5). Of the Enterobacteriaceae (n = 84), 88% were sensitive to gentamicin, 81% to ciprofloxacin, 91% to piperacillin-tazobactam and 100% were sensitive to meropenem.Three-month case mortality was 25.3% (n = 24). Ten patients (11.9%) had more than one Gram-negative bacteraemia; of these, nine patients (90.0%) were the same causative organism, predominantly E. coli.
  
  
  CONCLUSIONS
  CVCs and diabetic foot ulcers remain significant risk factors for Gram-negative bacteraemia, highlighting the importance of vascular access planning. Despite good levels of antibiotic sensitivity, the early mortality following Gram-negative bacteraemia remains high, supporting aggressive treatment of such pathogens.
authors.affiliation: Renal Unit, Western Infirmary, Glasgow, UK.
authors.forename: Eleanor C
authors.initials: EC
authors.lastname: Murray
authors.affiliation: Medical Microbiology, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Marek
authors.affiliation: Renal Unit, Western Infirmary, Glasgow, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Thomson
authors.affiliation: Medical Microbiology, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: John E
authors.initials: JE
authors.lastname: Coia
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative; bacteraemia; haemodialysis; sensitivity; vascular access