Infectious diseases are the leading cause of hospitalization and the second leading cause of death in patients receiving dialysis
Hemodialysis and peritoneal dialysis (PD) access sites are entry points for bacteremia and peritonitis, respectively. The incidence of hemodialysis-related bacteremia and PD peritonitis is 0.42 and 0.3 per patient year, respectively.1,2 With dialysis, sepsis mortality is 100 to 300 times higher than in the general population.3
Infections associated with the access site may be local, systemic, or both
Redness, tenderness, or discharge around the access site suggests infection. However, even if the access site appears normal, patients with sepsis or fever should be evaluated and antibiotics initiated.
Staphylococcus Species that are part of the skin flora are the most common bacteria involved in infections
Empirical methicillin resistance Staphylococcus aureus Because the risk of developing a MRSA infection from dialysis is 100 times higher than the general population, insurance coverage for access site-related infections (MRSA) is guaranteed.1
Treatment of hemodialysis access site infections includes antimicrobial therapy and possibly line removal or antibiotic lock therapy.
Removal of the line is recommended for persistent bacteremia (more than 3 days) or if blood cultures are positive for bacteremia. Staphylococcus aureus, Pseudomonas aeruginosaor Candida. When combined with systemic antibiotics and antibiotic lock therapy (instillation of a concentrated solution of antibiotics and anticoagulant in the catheter lumen when not in use), the success rate for catheter retrieval is 50%. , may be appropriate even if the access site is known to be a source of infection. Bacteremia.Four Consultation with an infectious disease specialist can help with decisions regarding treatment duration, line removal and reinsertion, and surgical arteriovenous graft resection.
Treatment of PD catheter infections includes antimicrobial therapy and possible catheter removal.
Catheter removal is performed in all cases of recurrent or refractory peritonitis, fungal peritonitis, and in local infections that progress to peritonitis or do not respond to antibiotics. In PD catheter peritonitis, intraperitoneal antibiotics with antifungal prophylaxis are preferred over systemic antibiotics unless septic features are present (Appendix 1, www.cmaj.ca/lookup/doi/10.1503/cmaj.231300 /tab-popular-content). . There is no need to switch to hemodialysis unless the PD catheter is removed.Five
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