Metastatic infectious complications in tunneled dialysis catheter-associated infections: a single-center experience

Year 2022, Volume: 5 Issue: 1, 178 - 183, 17.01.2022

Ercan Türkmen

https://doi.org/10.32322/jhsm.1027252

Abstract

Aim: Although the guidelines recommend arteriovenous fistula (AVF) primarily as vascular access in hemodialysis patients, tunneled catheter (TC) use is gradually increasing. TCs are associated with an increased risk of infection. TC infections can cause many metastatic infectious complications such as infective endocarditis (IE), spondylodiscitis (SpD), and paravertebral abscess. This study aimed to determine the frequency, risk factors, and prognosis of metastatic infectious complications in patients admitted to our hospital with TC infections.
Material and Method: Patients with TCs hospitalized to the Nephrology unit of Ondokuz Mayıs University Hospital between January 1, 2015, and January 1, 2020, with catheter infection, were included in the study. Demographic, clinical, and microbiological information was obtained from the patients' medical records retrospectively. Metastatic infectious complications were defined as IE, SpD, paravertebral or epidural abscess, and septic embolisms in any focus. Binary logistic regression analyzes were used to identify risk factors for metastatic infectious complications.
Results: One hundred and forty-eight catheter episodes were included in the study. Eighty-seven (58.8%) of the patients were women. Metastatic infectious complications developed in 22 (14.9%) of the patients. Of these, ten patients had IE, ten patients had SpD, and two patients had both IE and SpD. Coagulase-negative staphylococci was obtained as pathogenic microorganism in most cases (9/22, 49%). Patients with infectious complications had higher length of hospital stay [46.5 (10-171) vs 18 (6-92); p<0.001], and higher rates of sepsis (50% vs 16.7%; p<0.001), need for intensive care unit (36.4% vs 12.7%; p=0.005), and death (36.4% vs 11.9%; p=0.003). In multivariate binary logistic regression analysis, diabetes mellitus (DM) [OR: 7,813; 95% CI (2.05–29,783); p=0.003] and catheter duration [OR: 1.002; 95% CI (1-1,003); p=0.009] were identified as risk factors associated with metastatic infectious complications.
Conclusion: Metastatic infectious complications are associated with significant morbidity and mortality in hemodialysis patients. Long catheter duration and the presence of DM are risk factors for infectious complications. As recommended in international guidelines, minimizing the use of catheters and preventing the development of catheter infection by paying attention to basic hygiene rules, especially in diabetic patients, will help prevent these serious complications.

Keywords

hemodialysis, infective endocarditis, spondylodiscitis, tunnelled catheter

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