Renal replacement therapy and bloodstream infections in cardiovascular intensive care patients

Objective

To describe bloodstream infection epidemiology in cardiac patients undergoing hemodialysis admitted to ICUs.

Methods

We analyzed epidemiological data of laboratorial-confirmed bloodstream infection (BSI) episodes occurring in patients undergoing hemodialysis from October 2004 to March 2005. BSI criteria were defined by the Centers for Disease Control and Prevention. The presence of uncuffed, nontunneled, temporary central catheters for hemodialysis and other central venous catheters was daily monitored. BSI episodes were classified as dialysis-related when they occurred within 48 hours after this procedure.

Results

There were 20 BSI episodes in 16 patients among the 168 (9.5%) who underwent hemodialysis in that period. The mean age was 73.5 ± 9.8 years and the mean ICU length of stay before BSI was 31.5 days. Eight patients (50%) were in the postoperative period. At hospital admission five (31%) patients had normal renal function, nine (56%) presented acute nondialytic chronic renal failure and only one had dialytic chronic renal failure. Sixteen episodes (80%) were hemodialysis related: 10 (62.5%) after continuous vein-venous hemodialysis (low-flux hemodialysis) and six (37.5%) after classic hemodialysis (high-flux hemodialysis). There was no statistically significant difference between these two procedures (P = 0.51). The most common pathogen was methicillin-resistant Staphylococcus aureus in seven cases. Three blood cultures had two agents and only one had Candida tropicalis. Nine catheters (45%) were inserted in the femoral vein, eight (40%) in the subclavian vein and three in the jugular (15%). Nine patients (56.3%) died within 15 days after BSI episodes.

Conclusion

BSI incidence was higher in old patients and those with a long ICU length of stay. It was lower in patients who underwent classic hemodialysis, which is carried out by skilled nurses from the Dialysis Program. Clinical patients' conditions and technical aspects of this approach influenced the data.