Cibele Grothe

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

O objetivo deste estudo foi avaliar a incidencia e os fatores de risco de infeccao da corrente sanguinea (ICS) em pacientes com cateter venoso central (CVC) duplo lumen, para hemodialise (HD) e identificar os micro-organismos isolados na corrente sanguinea. Como metodo, usou-se o follow up, realizado no periodo de um ano, incluindo todos os 156 pacientes que estavam em tratamento de HD por CVC duplo lumen, na Universidade Federal de Sao Paulo - UNIFESP. Os resultados mostraram que dos 156 pacientes estudados, 94 apresentaram ICS, desses, 39 tiveram culturas positivas no local de insercao do cateter. Dos 128 micro-organismos isolados da corrente sanguinea, 53 eram S.aureus, dos quais 30 eram sensiveis a metilcilina e 23 resistentes. Entre as complicacoes relacionadas a ICS, houve 35 casos de septicemia e 27 casos de endocardite, dos quais 15 progrediram a obito. A incidencia de ICS neste grupo de pacientes mostrou-se bastante elevada bem como sua progressao para quadros infecciosos de grande magnitude e obito.This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case–control study

BackgroundInfection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.MethodsRisk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.ResultsThere were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09).ConclusionsInfection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

Screening and treatment for Staphylococcus aureus in patients undergoing hemodialysis: a systematic review and meta-analysis

BackgroundThis study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.MethodsA systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were “Staphylococcus aureus”, “MRSA”, “MSSA”, “treatment”, “decolonization”, “nasal carrier”, “colonization”, “chronic kidney disease”, “dialysis”, and “haemodialysis” or “hemodialysis”. Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.ResultsIn total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05–0.34; p < 0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08–0.42; p < 0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51–1.15; p = 0.20).ConclusionsTwenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.

Incidência de infecção da corrente sanguínea nos pacientes submetidos à hemodiálise por cateter venoso central

O objetivo deste estudo foi avaliar a incidencia e os fatores de risco de infeccao da corrente sanguinea (ICS) em pacientes com cateter venoso central (CVC) duplo lumen, para hemodialise (HD) e identificar os micro-organismos isolados na corrente sanguinea. Como metodo, usou-se o follow up, realizado no periodo de um ano, incluindo todos os 156 pacientes que estavam em tratamento de HD por CVC duplo lumen, na Universidade Federal de Sao Paulo - UNIFESP. Os resultados mostraram que dos 156 pacientes estudados, 94 apresentaram ICS, desses, 39 tiveram culturas positivas no local de insercao do cateter. Dos 128 micro-organismos isolados da corrente sanguinea, 53 eram S.aureus, dos quais 30 eram sensiveis a metilcilina e 23 resistentes. Entre as complicacoes relacionadas a ICS, houve 35 casos de septicemia e 27 casos de endocardite, dos quais 15 progrediram a obito. A incidencia de ICS neste grupo de pacientes mostrou-se bastante elevada bem como sua progressao para quadros infecciosos de grande magnitude e obito.This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case–control study

BackgroundInfection is the leading cause of morbidity and the second most frequent cause of mortality among patients on renal replacement therapy. A major morbid event in this population is hospitalization because of infection. The aim of this study was to investigate the risk factors for morbidity and mortality related to bloodstream infection (BSI) among patients on hemodialysis.ResultsRisk factors for morbidity and mortality related to BSI in patients on hemodialysis were investigated retrospectively by nested case–control, from January 2010 to June 2013. Patients were divided into two groups: those who progressed to hospitalization or death due to BSI (Group 1) and those who developed BSI, but did not progress to the same outcome (Group 2). Data were collected through consultation of patient records. For statistical analysis, logistic regression was used. There were 32 patients in Group 1 and 61 in Group 2. Logistic regression verified that, for each year of age, the chance of death or hospitalization for BSI increased 1.05 times [95% confidence interval (CI): 1.02–1.09]. Patients with BSI caused by Staphylococcus aureus had an 8.67 times higher chance of progressing to death or hospitalization (95% CI: 2.5–30.06). The isolation of multiresistant microorganisms in blood cultures of hemodialysis patients increased morbidity and mortality by 2.75 times (95% CI: 1.01–7.48).ConclusionIndependent risk factors for morbidity and mortality among patients after developing BSI during hemodialysis were: age, blood culture positive for S. aureus, and antibiotic resistance. Control measures to prevent microbial dissemination, primarily the multiresistant ones, should be intensified in this population. More studies are needed to standardize specific measures not yet classically standardized, such as collection of surveillance culture samples, contact precautions, and decolonization.

Prophylactic use of Mupirocin in hemodialysis central venous catheters: a systematic review and meta-analysis

OBJETIVO: Evaluar el impacto del uso de Mupirocina topica en insercion de cateter venoso central para hemodialisis. METODOS: Revision Sistematica con Metaanalisis. RESULTADOS: Despues de una criteriosa y extensa busqueda, se incluyeron tres ensayos clinicos que compararon el uso de Mupirocina versus otra intervencion en cateter venoso central para hemodialise. CONCLUSION: El estudio demostro que el uso de Mupirocina topica es eficaz para la reduccion de los episodios de infecciones entre los pacientes en hemodialisis, aumentando el tiempo de utilizacion del cateter, ademas de reducir significativamente las infecciones por S aureus, las mas prevalentes en esa poblacion.

Prevalence of infection in kidney transplantation from living versus deceased donor: systematic review and meta-analysis

OBJETIVO Verificar se o tipo de doador e fator de risco para infeccao nos pacientes transplantados renais. METODO Revisao Sistematica da Literatura com Metanalise realizada nas bases de dados MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO e CINAHL. RESULTADOS Foram selecionados 198 artigos e incluidos quatro estudos observacionais que descreveram as infeccoes apresentadas entre os pacientes distinguindo o tipo de doador. Atraves da metanalise, foi evidenciado que em pacientes submetidos a transplante de doador falecido, o desfecho infeccao foi 2,65 maior, em relacao aos que recebem o orgao de doador vivo. CONCLUSAO O estudo permitiu verificar que receptores de rim de doador falecido apresentam maior risco para o desenvolvimento de infeccoes e que emerge a necessidade de estabelecimento e cumprimento de protocolos desde o manejo adequado do tempo de isquemia a prevencao e controle de infeccao nesta populacao.OBJECTIVE To verify if the type of donor is a risk factor for infection in kidney transplant recipients. METHODS Systematic Review of Literature with Meta-analysis with searches conducted in the databases MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS We selected 198 studies and included four observational studies describing infections among patients distinguishing the type of donor. Through meta-analysis, it was shown that in patients undergoing deceased donor transplant, the outcome infection was 2.65 higher, than those who received an organ from a living donor. CONCLUSION The study showed that deceased kidney donor recipients are at an increased risk for developing infections and so the need for establishing and enforcing protocols from proper management of ischemic time to the prevention and control of infection in this population emerges.

Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise

OBJETIVO: Evaluar el impacto del uso de Mupirocina topica en insercion de cateter venoso central para hemodialisis. METODOS: Revision Sistematica con Metaanalisis. RESULTADOS: Despues de una criteriosa y extensa busqueda, se incluyeron tres ensayos clinicos que compararon el uso de Mupirocina versus otra intervencion en cateter venoso central para hemodialise. CONCLUSION: El estudio demostro que el uso de Mupirocina topica es eficaz para la reduccion de los episodios de infecciones entre los pacientes en hemodialisis, aumentando el tiempo de utilizacion del cateter, ademas de reducir significativamente las infecciones por S aureus, las mas prevalentes en esa poblacion.

Prevalencia de infección en trasplante renal de donante vivo versus fallecido: revisión sistemática y metanálisis

OBJETIVO Verificar se o tipo de doador e fator de risco para infeccao nos pacientes transplantados renais. METODO Revisao Sistematica da Literatura com Metanalise realizada nas bases de dados MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO e CINAHL. RESULTADOS Foram selecionados 198 artigos e incluidos quatro estudos observacionais que descreveram as infeccoes apresentadas entre os pacientes distinguindo o tipo de doador. Atraves da metanalise, foi evidenciado que em pacientes submetidos a transplante de doador falecido, o desfecho infeccao foi 2,65 maior, em relacao aos que recebem o orgao de doador vivo. CONCLUSAO O estudo permitiu verificar que receptores de rim de doador falecido apresentam maior risco para o desenvolvimento de infeccoes e que emerge a necessidade de estabelecimento e cumprimento de protocolos desde o manejo adequado do tempo de isquemia a prevencao e controle de infeccao nesta populacao.OBJECTIVE To verify if the type of donor is a risk factor for infection in kidney transplant recipients. METHODS Systematic Review of Literature with Meta-analysis with searches conducted in the databases MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS We selected 198 studies and included four observational studies describing infections among patients distinguishing the type of donor. Through meta-analysis, it was shown that in patients undergoing deceased donor transplant, the outcome infection was 2.65 higher, than those who received an organ from a living donor. CONCLUSION The study showed that deceased kidney donor recipients are at an increased risk for developing infections and so the need for establishing and enforcing protocols from proper management of ischemic time to the prevention and control of infection in this population emerges.

Prevalência de infecção em transplante renal de doador vivo versus falecido: revisão sistemática e metanálise

OBJETIVO Verificar se o tipo de doador e fator de risco para infeccao nos pacientes transplantados renais. METODO Revisao Sistematica da Literatura com Metanalise realizada nas bases de dados MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO e CINAHL. RESULTADOS Foram selecionados 198 artigos e incluidos quatro estudos observacionais que descreveram as infeccoes apresentadas entre os pacientes distinguindo o tipo de doador. Atraves da metanalise, foi evidenciado que em pacientes submetidos a transplante de doador falecido, o desfecho infeccao foi 2,65 maior, em relacao aos que recebem o orgao de doador vivo. CONCLUSAO O estudo permitiu verificar que receptores de rim de doador falecido apresentam maior risco para o desenvolvimento de infeccoes e que emerge a necessidade de estabelecimento e cumprimento de protocolos desde o manejo adequado do tempo de isquemia a prevencao e controle de infeccao nesta populacao.OBJECTIVE To verify if the type of donor is a risk factor for infection in kidney transplant recipients. METHODS Systematic Review of Literature with Meta-analysis with searches conducted in the databases MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS We selected 198 studies and included four observational studies describing infections among patients distinguishing the type of donor. Through meta-analysis, it was shown that in patients undergoing deceased donor transplant, the outcome infection was 2.65 higher, than those who received an organ from a living donor. CONCLUSION The study showed that deceased kidney donor recipients are at an increased risk for developing infections and so the need for establishing and enforcing protocols from proper management of ischemic time to the prevention and control of infection in this population emerges.