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NDT Advance Access originally published online on August 5, 2006
Nephrology Dialysis Transplantation 2006 21(11):3185-3188; doi:10.1093/ndt/gfl425
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Catheter-related bacteraemia in haemodialysis patients with HIV infection

Dana Mitchell, Zipporah Krishnasami and Michael Allon

Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA

Correspondence and offprint requests to: Michael Allon, MD, Division of Nephrology, PB, Room 226, 728 Richard Arrington Blvd, Birmingham, AL 35233, USA. Email: mdallon{at}uab.edu

Background. Tunnelled catheters are used for dialysis in over 25% of haemodialysis (HD) patients and are a major risk factor for bacteraemia. HIV-positive patients may be at particularly increased risk of catheter-related bacteraemia (CRB) due to their immunocompromised state. The present case-controlled study compared catheter-related bacteraemia with HIV-positive and HIV-negative haemodialysis patients.

Methods. Using a prospective computerized vascular access database, we identified 33 HIV-positive haemodialysis patients who had a tunneled dialysis catheter placed during a 6.5-year period. Their catheter outcomes were compared with those observed in 55 age-, sex- and access date-matched control haemodialysis patients.

Results. The two groups were similar in terms of age, sex, diabetes, hypertension and peripheral vascular disease, but the HIV patients were more likely to be black (94 vs 76%, P = 0.03). CRB occurred in 52% of the HIV patients and 49% of the controls (P = 0.83). The median infection-free catheter survival was similar in HIV-positive and negative patients (165 vs 119 days, P = 0.12). Among patients with CRB, the likelihood of a Gram-negative infection was similar in both groups (18 vs 30%, P = 0.37). However, polymicrobial CRB was more likely in HIV patients (41 vs 15%, P = 0.049). HIV-positive patients were more likely to be hospitalized for treatment of CRB than HIV-negative patients (29 vs 7%, P = 0.05).

Conclusion. CRB is equally likely in HIV-positive and control haemodialysis patients. However, CRB is likely to be more severe in HIV-positive patients, as judged from the greater likelihood of polymicrobial infection and of hospitalization.

Keywords: catheter; HIV; infection; vascular access


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