Nephrology Dialysis Transplantation, Vol 13, Issue 11 2847-2852, Copyright © 1998 by Oxford University Press
J Nielsen, S Ladefoged and H Kolmos
Background: Dialysis catheters are a common cause of
nosocomial septicaemia in haemodialysis units-usually due to staphylococci,
of which Staphylococcus aureus is the most pathogenic.
In this study, the epidemiology and pathogenesis of dialysis
catheter-related infections were studied, and methods to identify patients
with these infections were evaluated. Methods: A
one-year prospective study of 67 catheters in 43 haemodialysis patients
were performed. Details about patients and catheters were obtained
successively during the catheter period, and biochemical parameters
expected to be related to infection were measured. After catheter
insertion, all patients were screened for nasal carriage of
S.aureus, and a culture was taken from the skin
overlying the catheter insertion site. Once a week, cultures were taken
from the insertion site and from the hub, and aerobic and anaerobic blood
cultures were drawn from the catheter. If clinical signs of septicaemia
occurred, peripheral blood cultures were also performed, when it was
possible. Results: The incidence of septicaemia was
49% (21/43) in patients, and 56% of all cases were caused by
S.aureus. The mortality was 14% (3/21) and the
incidence of severe secondary complications to septicaemia was 24% (5/31).
In all, 80% of all severe complications and 75% of all deaths from
septicaemia were due to S.aureus. With respect to
S.aureus septicaemia, the predictive values of
positive (P) and negative (N) S.aureus cultures were
as follows: nasal culture, P=36% (10/28), N=90% (35/39); culture from the
insertion site, P=72% (13/18), N=98% (48/49); and culture from the hub,
P=75% (3/4), N=83% (52/63). The risk ratio for
S.aureus septicaemia was 26.2 (6.1-113), P=0.0001,
according to the presence of S.aureus at the insertion
site, and 3.3 (0.74-15.1), P=0.12 according to nasal carriage of
S.aureus. The frequency of
S.aureus phage-type Group 2 (43%) was much higher than
the general frequency of this phage-type in Denmark, which is about 23%.
Catheter blood cultures were positive although there were no clinical signs
of septicaemia in 34% (23/67) of all catheter periods-84% of these were due
to coagulase-negative staphylococci. Conclusions:
Dialysis catheter-related S.aureus septicaemia was
highly unlikely if the patient had not been carrying
S.aureus in the nose or at the insertion site during
the time the catheter was in place. The best predictor of dialysis
catheter-related S.aureus septicaemia was a positive
S.aureus culture from the insertion site. Positive
catheter blood cultures unrelated to any clinical signs of septicaemia
occurred in one-third of all catheter periods, and 84% of these were due to
coagulase-negative staphylococci. Key words: central
venous-catheters; diagnosis; dialysis; dialysis catheters; septicaemia;
Staphylococcus aureus
ORIGINAL ARTICLES
Dialysis catheter-related septicaemia - focus on Staphylococcus aureus septicaemia
Departments of Clinical Microbiology and Nephrology, Hvidovre Hospital, Kettegård Allé 30, DK-2640 Hvidovre, Denmark; Corresponding author
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