American Journal of Kidney Diseases
Volume 56, Issue 3 , Pages 566-577 , September 2010

Epidemiology, Surveillance, and Prevention of Bloodstream Infections in Hemodialysis Patients

Received 10 September 2009 ,Accepted 25 February 2010.

References 

  1. Patel PR, Thompson ND, Kallen AJ, Arduino MJ. Epidemiology, surveillance and prevention of hepatitis C virus infections in hemodialysis patients [published online ahead of print 2010]. Am J Kidney Dis. doi:10.1053/j.ajkd.2010.01.025.
  2. US Renal Data System. USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2008;
  3. Tokars JI. Bloodstream infections in hemodialysis patients: getting some deserved attention. Infect Control Hosp Epidemiol. 2002;23:713–715
  4. Laupland KB, Gregson DB, Zygun DA, Dig CJ, Mortis G, Church DL. Severe bloodstream infections: a population-based assessment. Crit Care Med. 2004;32:992–997
  5. Engemann JJ, Friedman JY, Reed SD, et al. Clinical outcomes and costs due to Staphylococcus aureus bacteremia among patients receiving long-term hemodialysis. Infect Control Hosp Epidemiol. 2005;26:534–539
  6. Nissenson AR, Dylan ML, Griffiths RI, et al. Clinical and economic outcomes of Staphylococcus aureus septicemia in ESRD patients receiving hemodialysis. Am J Kidney Dis. 2005;46:301–308
  7. Li Y, Friedman JY, O'Neal BF, et al. Outcomes of Staphylococcus aureus infection in hemodialysis-dependent patients. Clin J Am Soc Nephrol. 2009;4:428–434
  8. Maraj S, Jacobs LE, Kung S-C, et al. Epidemiology and outcome of infective endocarditis in hemodialysis patients. Am J Med Sci. 2002;324:254–260
  9. Kamalakannan D, Pai RM, Johnson LB, Gardin JM, Saravolatz LD. Epidemiology and clinical outcomes of infective endocarditis in hemodialysis patients. Ann Thorac Surg. 2007;83:2081–2086
  10. Spies C, Madison JR, Schatz IJ. Infective endocarditis in patients with end-stage renal disease: clinical presentation and outcome. Arch Intern Med. 2004;164:71–75
  11. Klevens RM, Edwards JR, Andrus ML, Peterson KD, Dudeck TC, Horan TC. Dialysis surveillance report: National Healthcare Safety Network—data summary for 2006. Semin Dial. 2008;21:24–28
  12. Stevenson KB, Hannah EL, Lowder CA, et al. Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF: KDOQI clinical practice guidelines for vascular access. Am J Kidney Dis. 2002;39:549–555
  13. Stevenson KB, Adcox MJ, Mallea MC, Narasimhan N, Wagnild JP. Standardized surveillance of hemodialysis vascular access infections: 18-month experience at an outpatient, multifacility hemodialysis center. Infect Control Hosp Epidemiol. 2000;21:200–203
  14. Dopirak M, Hill C, Oleksiw M, et al. Surveillance of hemodialysis-associated primary bloodstream infections: the experience of ten hospital-based centers. Infect Control Hosp Epidemiol. 2002;23:721–724
  15. Allon M. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004;44:779–791
  16. Cooper RI, Saad TF. Prevention of bacteremia in patients with tunneled cuffed “permanent” hemodialysis catheters using gentamicin catheter packing [abstract]. J Am Soc Nephrol. 1999;10:203A
  17. Pervez A, Ahmed M, Ram S, et al. Antibiotic lock technique for prevention of cuffed tunnel catheter associated bacteremia. J Vasc Access. 2002;3:108–113
  18. McIntyre CW, Hulme LJ, Taal M, Fluck RJ. Locking of tunneled hemodialysis catheters with gentamicin and heparin. Kidney Int. 2004;66:801–805
  19. Saxena AK, Panhotra BR, Sundaram DS, et al. Tunneled catheters' outcome optimization among diabetics on dialysis through antibiotic-lock placement. Kidney Int. 2006;70:1629–1635
  20. Taylor G, Gravel D, Johnston L, et al. Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients. Am J Infect Control. 2004;32:155–160
  21. Hannah EL, Stevenson KB, Lowder CA, et al. Outbreak of hemodialysis vascular access site infections related to malfunctioning permanent tunneled catheters: making the case for active infection surveillance. Infect Control Hosp Epidemiol. 2002;23:538–541
  22. Centers for Disease Control and Prevention. Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients—United States, 2005. MMWR Morbid Mortal Wkly Rep. 2007;56(9):197–199
  23. Lafrance J, Rahme E, Lelorier J, Iqbal S. Vascular access-related infections: definitions, incidence rates, and risk factors. Am J Kidney Dis. 2008;52:982–993
  24. Hoen B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998;9:869–876
  25. Yu VL, Goetz A, Wagener M, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis: efficacy of antimicrobial prophylaxis. N Engl J Med. 1986;315:91–96
  26. Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Morbid Mortal Wkly Rep. 2001;50(RR-5):1–46
  27. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Morbid Mortal Wkly Rep. 2002;51(RR-10):1–26
  28. National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations: 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, Vascular Access. New York, NY: National Kidney Foundation; 2006;http://www.kidney.org/Professionals/kdoqi/guideline_upHD_PD_VA/index.htmAccessed February 10, 2010
  29. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Vascular Access, update 2000. Am J Kidney Dis. 2001;37(1 suppl 1):S137–S181
  30. Mid-Atlantic Renal Coalition. 2009 Fistula First Breakthrough Initiative Annual Report. http://fistula.memberpath.com/LinkClick.aspx?fileticket=Q7ZDEJHrhOk%3D&tabid=39Accessed April 10, 2010
  31. Centers for Medicare & Medicaid Services. 2007 Annual Report: ESRD Clinical Performance Measures Project. Baltimore, MD: Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality; December 2007;http://www.cms.hhs.gov/CPMProject/Downloads/ESRDCPMYear2007Report.pdfAccessed February 10, 2010
  32. Lee T, Barker J, Allon M. Associations with predialysis vascular access management. Am J Kidney Dis. 2004;43:1008–1013
  33. Lacson E, Lazarus JM, Himmelfarb J, Ikizler TA, Hakim RM. Balancing fistula first with catheters last. Am J Kidney Dis. 2007;50:379–395
  34. Asif A, Cherla G, Merrill D, Cipleu CD, Briones P, Pennell P. Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula. Kidney Int. 2005;67:2399–2406
  35. Polkinghorne KR, Seneviratne M, Kerr PG. Effect of a vascular access nurse coordinator to reduce central venous catheter use in incident hemodialysis patients: a quality improvement report. Am J Kidney Dis. 2009;53:99–106
  36. Cavanaugh KL, Wingard RL, Hakim RM, Elasy TA, Ikizler TA. Patient dialysis knowledge is associated with permanent arteriovenous access use in chronic hemodialysis. Clin J Am Soc Nephrol. 2009;4:950–956
  37. Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis. 2005;46:501–508
  38. Rehman R, Schmidt RJ, Moss AH. Ethical and legal obligation to avoid long-term tunneled catheter access. Clin J Am Soc Nephrol. 2009;4:456–460
  39. Lok CE. Fistula First Initiative: advantages and pitfalls. Clin J Am Soc Nephrol. 2007;2:1043–1053
  40. Taylor GD, McKenzie M, Buchanan-Chell M, Cballo L, Chui L, Kowalewska-Grochowska K. Central venous catheters as a source of hemodialysis-related bacteremia. Infect Control Hosp Epidemiol. 1998;19:643–646
  41. Price CS, Hacek D, Noskin GA, Peterson LR. An outbreak of bloodstream infections in an outpatient hemodialysis center. Infect Control Hosp Epidemiol. 2002;23:725–729
  42. George A, Tokars JI, Clutterbuck EJ, Bamford KB, Pusey C, Holmes AH. Reducing dialysis associated bacteraemia, and recommendations for surveillance in the United Kingdom: prospective study. BMJ. 2006;332:1435–1439
  43. US Department of Health and Human Services, Centers for Medicare & Medicaid Services. Medicare and Medicaid programs; Conditions for Coverage for End-Stage Renal Disease Facilities; final rule (42 CFR Parts 405, 410, 413, 414, 488, and 494), 73. Fed Reg. 20370 (2008) http://www.cms.hhs.gov/cfcsandcops/downloads/esrdfinalrule0415.pdfAccessed February 10, 2010
  44. Arenas MD, Sanchez-Paya J, Barril G, et al. A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance. Nephrol Dial Transplant. 2005;20:1164–1171
  45. Shimokura G, Weber DJ, Miller WC, Wurtzel H, Alter MJ. Factors associated with personal protection equipment use and hand hygiene among hemodialysis staff. Am J Infect Control. 2006;34:100–107
  46. Maki DG, Ringer M, Alvarado CJ. Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338:339–343
  47. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med. 2002;136:792–801
  48. Mimoz O, Pieroni L, Lawrence C, et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med. 1996;24:1818–1823
  49. Hoffman K, Weber DJ, Samsa GP, Rutala WA. Transparent polyurethane film as an intravenous catheter dressing: a meta-analysis of the infection risks. JAMA. 1992;267:2072–2076
  50. Gillies D, Carr D, Frost J, O'Riordan E, Gunning R, O'Brien I. Gauze and tape and transparent polyurethane dressings for central venous catheters. Cochrane Database Syst Rev. 2003;(4):CD003827
  51. Timsit JF, Schwebel C, Bouadma C, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults. JAMA. 2009;301:1231–1241
  52. Ruschulte H, Franke M, Gastmeier P, et al. Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol. 2009;88:267–272
  53. Onder AM, Chandar J, Coakley S, Francoeur D, Abitbol C, Zilleruelo G. Controlling exit site infections: does it decrease the incidence of catheter-related bacteremia in children on chronic hemodialysis?. Hemodial Int. 2009;13:11–18
  54. Onder AM, Chandar J, Billings A, et al. Chlorhexidine-based antiseptic solutions effectively reduce catheter-related bacteremia. Pediatr Nephrol. 2009;24:1741–1747
  55. Crinch CJ, Halfmann BS, Crone WC, Maki DG. The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol. 2005;26:708–714
  56. Levin A, Mason AJ, Jindal KK, Fong IW, Goldstein MB. Prevention of hemodialysis subclavian vein catheter infections by topical povidone iodine. Kidney Int. 1991;40:934–938
  57. Sesso R, Barbosa D, Leme IL, et al. Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment. J Am Soc Nephrol. 1998;9:1085–1092
  58. Johnson DW, MacGinley R, Kay TD, et al. A randomized controlled trial of topical exit site mupirocin application in patients with tunneled, cuffed haemodialysis catheters. Nephrol Dial Transplant. 2002;17:1802–1807
  59. Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J. Hemodialysis infection prevention with Polysporin ointment. J Am Soc Nephrol. 2003;13:169–179
  60. Johnson DW, van Eps C, Mudge DW, et al. Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients. J Am Soc Nephrol. 2005;16:1456–1462
  61. Bard Access Systems. Instructions for Use: Niagara & Niagara Slim-Cath Dual Lumen Catheters. Salt Lake City: C.R. Bard, Inc. http://www.bardnordic.com/main/product.asp?sectionTypeId=2&sectionId=18&productId=159Accessed February 10, 2010
  62. Hendrickx L, Kuypers D, Evenepoel P, Maes B, Messiaen T, Vanrenterghem Y. A comparative prospective study on the use of low concentration citrate lock versus heparin lock in permanent dialysis catheters. Int J Artif Organs. 2001;24:208–211
  63. Dogra GK, Herson H, Hutchinson B, et al. Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: a randomized controlled study. J Am Soc Nephrol. 2002;13:2133–2139
  64. Betjes MG, van Arteren M. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution. Nephrol Dial Transplant. 2004;19:1546–1551
  65. Bleyer AJ, Mason L, Russell G, Raad II, Sheretz RJ. A randomized controlled trial of a new vascular catheter flush solution (minocycline EDTA) in temporary hemodialysis access. Infect Control Hosp Epidemiol. 2005;26:520–524
  66. Weijmer MC, van den Dorpel MA, Van de Ven PJ, et al. Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol. 2005;16:2769–2777
  67. Nori US, Manoharan A, Yee J, Besarab A. Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia. Am J Kidney Dis. 2006;48:596–605
  68. Al-Hweish AK, Abdul-Rahman IS. Successful prevention of tunneled, central catheter infection by antibiotic lock therapy using vancomycin and gentamicin. Saudi J Kidney Dis Transpl. 2007;18:239–247
  69. Duncan N, Singh S, Amao M. A single centre randomized control trial of sodium citrate versus heparin line locks for cuffed central venous catheters [abstract]. J Am Soc Nephrol. 2005;16:451A
  70. James MT, Conley J, Tonelli M, Manns BJ, Macrae J, Hemmelgarn BR. Meta-analysis: antibiotics for prophylaxis against hemodialysis catheter-related infections. Ann Intern Med. 2008;148:596–605
  71. Yahav D, Rozen-Zvi B, Gafter-Gvili A, Leibovici L, Gafter U, Paul M. Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis: systematic review and meta-analysis of randomized controlled trials. Clin Infect Dis. 2008;47:83–93
  72. Jaffer Y, Shelby NM, Taal MW, Fluck RJ, McIntyre CW. A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection. Am J Kidney Dis. 2008;51:233–241
  73. Labriola L, Crott R, Jadoul M. Preventing haemodialysis catheter-related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials. Nephrol Dial Transplant. 2007;23:1666–1672
  74. Abbas SA, Haloob IA, Taylor SL, et al. Effect of antimicrobial locks for tunneled hemodialysis catheters on bloodstream infection and bacterial resistance: a quality improvement report. Am J Kidney Dis. 2009;53:492–502
  75. Stranz M, Hadaway L. Risk of bacterial contamination from citrate catheter locks [letter]. Semin Dial. 2009;22:704
  76. Chatzinikolaou I, Finkel K, Hanna H, et al. Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter-related infections: a prospective, randomized study. Am J Med. 2003;115:352–357
  77. Trerotola SO, Johnson MS, Shah H, et al. Tunneled hemodialysis catheters: use of a silver-coated catheter for prevention of infection—a randomized study. Radiology. 1998;207:491–496
  78. Centers for Disease Control and Prevention. Reduction in central line-associated bloodstream infections among patients in intensive care units—Pennsylvania, April 2001-March 2005. MMWR Morbid Mortal Wkly Rep. 2005;54(40):1013–1016
  79. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355:2725–2732
  80. Delmarva Foundation. Hemodialysis Collaborative: provider resources. http://www.delmarvafoundation.org/providers/ambulatory/dialysis/index.htmlAccessed April 10, 2010

 Originally published online as doi:10.1053/j.ajkd.2010.02.352 on June 16, 2010.

 This is a US Government Work. There are no restrictions on its use.

PII: S0272-6386(10)00718-3

doi: 10.1053/j.ajkd.2010.02.352

American Journal of Kidney Diseases
Volume 56, Issue 3 , Pages 566-577 , September 2010