Document Detail


Clinical consequences of infected arteriovenous grafts in hemodialysis patients.
MedLine Citation:
PMID:  11684549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Arteriovenous (AV) graft infection is a serious adverse event in hemodialysis patients; however, there is little published literature describing its consequences. We identified prospectively all AV graft infections occurring at our institution during a 4.5-year period. We analyzed immediate complications, as well as long-term consequences, including the need for subsequent vascular-access procedures and duration of catheter-dependent dialysis therapy. Ninety graft infections were identified in 78 patients, yielding a rate of 8.2 infections/100 graft-years. Patients with graft infection were much more likely to have a low serum albumin level (<3.5 g/dL) in the month preceding the infection compared with noninfected controls (73% versus 18%; P < 0.001). Infections occurred within 1 month of graft placement in 15%, at 1 to 12 months in 44%, and longer than 1 year from surgery in 41%. The pathogen was a gram-positive coccus in 97% of cases, particularly Staphylococcus aureus (60%) and Staphylococcus epidermidis (22%). The initial graft infection entailed hospitalization for a mean of 7.5 days. Eleven patients (12%) developed a total of 17 major complications, including death (5 patients), clinical sepsis requiring vasopressors (4 patients), septic arthritis (3 patients), epidural abscess (1 patient), endocarditis (1 patient), osteomyelitis (1 patient), myocardial infarction (1 patient), and cerebrovascular accident (1 patient). After removal of an infected graft, patients were catheter dependent for a median of 3.8 months. The duration of catheter dependence was less than 3 months in 36%, 3 to 6 months in 38%, 6 to 12 months in 14%, and greater than 1 year in 12%. During the period of catheter dependence, patients required a mean of 9.7 access procedures, including graft removal (1.0 procedure), nontunneled dialysis catheters (4.4 procedures), tunneled dialysis catheters (3.0 procedures), and new permanent accesses (1.4 procedures). In addition, patients averaged 0.85 episodes of bacteremia while they were catheter dependent. In conclusion, graft infection results in substantial morbidity, prolonged dependence on dialysis catheters, and multiple vascular-access procedures.
Authors:
T E Minga; K H Flanagan; M Allon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  38     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-10-30     Completed Date:  2001-12-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  975-8     Citation Subset:  IM    
Affiliation:
Division of Nephrology, University of Alabama at Birmingham, AL, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / therapeutic use
Arteriovenous Shunt, Surgical / adverse effects*
Blood Vessel Prosthesis / adverse effects*
Catheters, Indwelling
Female
Hospitalization / statistics & numerical data
Humans
Male
Prosthesis-Related Infections / drug therapy,  etiology*,  microbiology
Renal Dialysis*
Serum Albumin / metabolism
Staphylococcal Infections / drug therapy,  etiology*,  microbiology
Staphylococcus aureus / drug effects
Staphylococcus epidermidis / drug effects
Time Factors
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Serum Albumin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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