Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil

Detalhes bibliográficos
Autor(a) principal: Gauna,Tamara Trelha
Data de Publicação: 2013
Outros Autores: Oshiro,Elizete, Luzio,Yuri Correa, Paniago,Anamaria Mello Miranda, Pontes,Elenir Rose Jardim Cury, Chang,Marilene Rodrigues
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista da Sociedade Brasileira de Medicina Tropical
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822013000400426
Resumo: Introduction 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-five (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.
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spelling Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western BrazilCatheterBloodstream infectionChronic renal patientsBacteremiaHemodialysis Introduction 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-five (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. Sociedade Brasileira de Medicina Tropical - SBMT2013-08-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822013000400426Revista da Sociedade Brasileira de Medicina Tropical v.46 n.4 2013reponame:Revista da Sociedade Brasileira de Medicina Tropicalinstname:Sociedade Brasileira de Medicina Tropical (SBMT)instacron:SBMT10.1590/0037-8682-0060-2013info:eu-repo/semantics/openAccessGauna,Tamara TrelhaOshiro,ElizeteLuzio,Yuri CorreaPaniago,Anamaria Mello MirandaPontes,Elenir Rose Jardim CuryChang,Marilene Rodrigueseng2013-12-13T00:00:00Zoai:scielo:S0037-86822013000400426Revistahttps://www.sbmt.org.br/portal/revista/ONGhttps://old.scielo.br/oai/scielo-oai.php||dalmo@rsbmt.uftm.edu.br|| rsbmt@rsbmt.uftm.edu.br1678-98490037-8682opendoar:2013-12-13T00:00Revista da Sociedade Brasileira de Medicina Tropical - Sociedade Brasileira de Medicina Tropical (SBMT)false
dc.title.none.fl_str_mv Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
title Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
spellingShingle Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
Gauna,Tamara Trelha
Catheter
Bloodstream infection
Chronic renal patients
Bacteremia
Hemodialysis
title_short Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
title_full Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
title_fullStr Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
title_full_unstemmed Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
title_sort Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil
author Gauna,Tamara Trelha
author_facet Gauna,Tamara Trelha
Oshiro,Elizete
Luzio,Yuri Correa
Paniago,Anamaria Mello Miranda
Pontes,Elenir Rose Jardim Cury
Chang,Marilene Rodrigues
author_role author
author2 Oshiro,Elizete
Luzio,Yuri Correa
Paniago,Anamaria Mello Miranda
Pontes,Elenir Rose Jardim Cury
Chang,Marilene Rodrigues
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Gauna,Tamara Trelha
Oshiro,Elizete
Luzio,Yuri Correa
Paniago,Anamaria Mello Miranda
Pontes,Elenir Rose Jardim Cury
Chang,Marilene Rodrigues
dc.subject.por.fl_str_mv Catheter
Bloodstream infection
Chronic renal patients
Bacteremia
Hemodialysis
topic Catheter
Bloodstream infection
Chronic renal patients
Bacteremia
Hemodialysis
description Introduction 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-five (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.
publishDate 2013
dc.date.none.fl_str_mv 2013-08-01
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1590/0037-8682-0060-2013
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Medicina Tropical - SBMT
publisher.none.fl_str_mv Sociedade Brasileira de Medicina Tropical - SBMT
dc.source.none.fl_str_mv Revista da Sociedade Brasileira de Medicina Tropical v.46 n.4 2013
reponame:Revista da Sociedade Brasileira de Medicina Tropical
instname:Sociedade Brasileira de Medicina Tropical (SBMT)
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instname_str Sociedade Brasileira de Medicina Tropical (SBMT)
instacron_str SBMT
institution SBMT
reponame_str Revista da Sociedade Brasileira de Medicina Tropical
collection Revista da Sociedade Brasileira de Medicina Tropical
repository.name.fl_str_mv Revista da Sociedade Brasileira de Medicina Tropical - Sociedade Brasileira de Medicina Tropical (SBMT)
repository.mail.fl_str_mv ||dalmo@rsbmt.uftm.edu.br|| rsbmt@rsbmt.uftm.edu.br
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