혈액투석 도관 감염의 임상적 특성과 치료 결과

Abstract

Background: Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients. Materials and Methods: Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access. Results: Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28(12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%)had a temporary central catheter. The mean±SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6±36.9 days, tunneled cuffed catheter 180.3±168.8 days, AV fistulas 928.6±1,299.7 days, and AV graft 1,066.3±1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%;methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%),tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12,33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%. Conclusions: Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.