Ten-Year Study of Bacteremia in Hemodialysis Patients in a Single Center

Kang, Yoo Na; Yoon, Sun Ae; Kwon, Jae Cheol; Kang, Ji Young; Kim, Tae Woo; Shin, Mi Jung; Kim, Young Soo; Lee, Dong Gun; Kim, Young Ok; Chang, Yoon Sik; Bang, Byung Kee

Abstract

BACKGROUND
The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. METHODS: We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication and mortality of bacteremia. We compared clinical factors, morbidity and mortality between arteriovenous fistula and central venous catheter groups. RESULTS: Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%) and staphylococcus aureus was most common. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n=4), aspiration pneumonia (n=2), hypoxic brain injury (n=1), gastrointestinal bleeding (n=1), and rupture of aortic pseudoaneurysm. Central venous catheter group (n= 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p<0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p=0.042) than arteriovenous group. CONCLUSION: This data showed that bacteremia caused high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early.