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Risk Factors Associated with Permanent Access-Site Infections in Chronic Hemodialysis Patients

Published online by Cambridge University Press:  02 January 2015

Robert A. Bonomo ,
Dora Rice ,
Christopher Whalen ,
David Linn ,
Elizabeth Eckstein  and
David M. Shlaes
Robert A. Bonomo*
Affiliation:
Division of Geriatrics, University Hospitals of Cleveland, Cleveland, Ohio
Dora Rice
Affiliation:
The Division of Infectious Diseases, Veterans' Affairs Medical Center, Cleveland, Ohio
Christopher Whalen
Affiliation:
General Internal Medicine, Veterans' Affairs Medical Center, Cleveland, Ohio The Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
David Linn
Affiliation:
Nephrology, Veterans' Affairs Medical Center, Cleveland, Ohio
Elizabeth Eckstein
Affiliation:
The Division of Infectious Diseases, Veterans' Affairs Medical Center, Cleveland, Ohio
David M. Shlaes
Affiliation:
The Division of Infectious Diseases, Veterans' Affairs Medical Center, Cleveland, Ohio
*
Fairhill Institute for the Elderly, 12200 Fairhill Rd, Cleveland, OH 44120
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Abstract

Objective:

To determine the epidemiological risk factors associated with permanent access-site (PAS) infection in a population of chronic hemodialysis patients.

Design:

Retrospective cohort analysis.

Seiting:

Hemodialysis unit of a 400-bed Department of Veterans' Affairs hospital.

Results:

A cohort of 94 males (1,316 patient months) was studied. Fifty-one PAS infections in 31 patients were observed. SiX patients had two PAS infections, four patients had three infections, and two patients had four infections. Twenty-nine of the 31 patients with PAS infections were bacteremic at least once. Univariate analysis identified seven factors significantly associated with PAS infection in this population: location of PAS other than forearm, type of vascular access (poletrafluoroethylene [PTFE] versus endogenous arteriovenous [AV] fistula), limited ambulatory status, residence in a nursing home, bacterial infection at a distant site, number of access-site revisions, and number of hospitalizations. In a logistic regression analysis, only graft type and number of PTFE graft revisions were associated independently with PAS infection. The odds ratio for PAS infection in PTFE grafts compared to endogenous AV fistula was 7.8; the odds ratio for PAS infection with each PTFE graft revision was 1.5.

Conclusions:

PAS infections were associated independently with the type of graft and the number of PTFE graft surgical revisions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 11 , November 1997 , pp. 757 - 761
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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