title: Catheter-Related Bloodstream Infections in Patients on Emergent Hemodialysis.
abstract: OBJECTIVE
  This study had 2 objectives: (1) to describe the epidemiology of catheter-related bloodstream infections (CRBSI) in patients with end-stage renal disease (ESRD) who have no access to scheduled dialysis and (2) to evaluate whether a positive culture of the heparin-lock solution is associated with subsequent development of bacteremia.
  
  
  METHODS
  Retrospective observational cohort design for objective 1; and prospective cohort design for objective 2.
  
  
  METHODS
  The study was conducted in a 770-bed public academic tertiary hospital in Dallas, Texas. The participants were patients with ESRD undergoing scheduled or emergent hemodialysis.
  
  
  METHODS
  We reviewed the records of 147 patients who received hemodialysis between January 2011 and May 2011 and evaluated the rate of CRBSI in the previous 5 years. For the prospective study, we cultured the catheter heparin-lock solution in 62 consecutive patients between June 2012 and August 2012 and evaluated the incidence of CRBSI at 6 months.
  
  
  RESULTS
  Of the 147 patients on emergent hemodialysis, 125 had a tunneled catheter, with a CRBSI rate of 2.61 per 1,000 catheter days. The predominant organisms were Gram-negative rods (GNR). In the prospective study, we found that the dialysis catheter was colonized more frequently in patients on emergent hemodialysis than in those on scheduled hemodialysis. Colonization with GNR or Staphylococcus aureus was associated with subsequent CRBSI at 6 months follow-up.
  
  
  CONCLUSIONS
  Patients undergoing emergent hemodialysis via tunneled catheter are predisposed to Gram-negative CRBSI. Culturing the heparin-lock solution may predict subsequent episodes of CRBSI if it shows colonization with GNR or Staphylococcus aureus. Prevention approaches in this population need to be studied further.
authors.affiliation: 1Division of Infectious Diseases,Department of Internal Medicine,University of Texas Southwestern Medical Center,Dallas,Texas.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Rojas-Moreno
authors.affiliation: 2University of Texas Southwestern Medical School,Dallas,Texas.
authors.forename: Daniel
authors.initials: D
authors.lastname: Spiegel
authors.affiliation: 3Division of Nephrology,Department of Internal Medicine,University of Texas Southwestern Medical Center,Dallas,Texas.
authors.forename: Venkata
authors.initials: V
authors.lastname: Yalamanchili
authors.affiliation: 3Division of Nephrology,Department of Internal Medicine,University of Texas Southwestern Medical Center,Dallas,Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuo
authors.affiliation: 3Division of Nephrology,Department of Internal Medicine,University of Texas Southwestern Medical Center,Dallas,Texas.
authors.forename: Henry
authors.initials: H
authors.lastname: Quinones
authors.affiliation: 1Division of Infectious Diseases,Department of Internal Medicine,University of Texas Southwestern Medical Center,Dallas,Texas.
authors.forename: Pranavi V
authors.initials: PV
authors.lastname: Sreeramoju
authors.affiliation: 1Division of Infectious Diseases,Department of Internal Medicine,University of Texas Southwestern Medical Center,Dallas,Texas.
authors.forename: James P
authors.initials: JP
authors.lastname: Luby
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D062606:Tertiary Care Centers; D013781:Texas
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006493:Heparin