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Bacteremia dialysis

Tze Liang Goh, Jason Wei, David Semple, John Collins
The use of antibiotic lock solutions as prophylaxis for catheter-associated blood stream infection (CRBSI) has been shown to be effective in previous randomized controlled trials. However, the cost-effectiveness of this approach had not been studied. In 2012, the routine gentamicin-heparin lock solution used in Auckland City Hospital was withdrawn from the market, leading to a change to heparin-only lock. This was then replaced with gentamicin-citrate lock in 2014. This situation allowed review of the CRBSI rate and financial impact of different catheter lock solutions...
June 2017: Nephrology
Eric Wenzler, Kristen L Bunnell, Susan C Bleasdale, Scott Benken, Larry H Danziger, Keith A Rodvold
Ceftazidime-avibactam 1.25 g every 8 hours was used to treat multi-drug resistant Pseudomonas aeruginosa bacteremia in a critically ill patient on continuous venovenous hemofiltration (CVVH). Pre-filter plasma drug concentrations of ceftazidime and avibactam were measured at 0, 1, 2, 4, 6, and 8 hours along with post-filter and ultrafiltrate concentrations at hours 2 and 6. Plasma pharmacokinetic parameters of ceftazidime and avibactam, respectively, were Cmax 61.10 and 14.54 mg/L, Cmin 31.96 and 8.45 mg/L, t1/2 6...
April 17, 2017: Antimicrobial Agents and Chemotherapy
Daniel Shepshelovich, Dana Yelin, Lior Or Bach, Noy Halevy, Yonatan Ziv, Hefziba Green, Benaya Rozen-Zvi, Haim Ben-Zvi, Jihad Bishara, Anat Gafter-Gvili, Dafna Yahav
INTRODUCTION: Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established, and empirical broad-spectrum antibiotics are usually the rule. METHODS: We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection...
December 16, 2016: American Journal of Medicine
Jacob B Morton, Haley J Morrill, Kerry L LaPlante, Aisling R Caffrey
INTRODUCTION: Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality. However, literature regarding mortality is often limited to invasive pneumococcal disease, excluding pneumonia. This study sought to identify predictors of mortality among adults with serious pneumococcal disease, including pneumonia and invasive pneumococcal disease. METHODS: This was a nested case-control study of unvaccinated older Veterans with positive S...
December 14, 2016: American Journal of Preventive Medicine
Aaron Wightman
BACKGROUND: Time-limited trials of dialysis have been proposed as a third option in addition to initiation of treatment and comfort-care only in the setting of high uncertainty or discordance between the treating team and child/family or among the treating team. CASE-DIAGNOSIS/TREATMENT: The index case was noted antenatally to have severe kidney disease and pulmonary hypoplasia. In light of the guarded, but uncertain prognosis and a lack of consensus among the treating team, as well as between the treating team and the family, a time-limited trial of dialysis was initiated...
December 9, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Claudia M D de Maio Carrillho, Juliana J Gaudereto, Roberta Cristina Ruedas Martins, Victor Augusto Camarinha de Castro Lima, Larissa M de Oliveira, Mariana R Urbano, Jamile S Perozin, Anna Sara Levin, Silvia F Costa
We described 27 polyclonal colistin-resistant Enterobacteriaceae (MIC 4-16 μg/mL) infections (12 pneumonia, 12 urinary tract infection (UTI), two Bacteremia, and one skin/soft tissue infection) in which 74% harbored KPC. The isolates were polyclonal, 6 STs were identified and the colistin resistance was due to chromosome mutations. Eight patients with UTI received monotherapy, and combination therapy was given to 19 patients. Overall mortality was 37%. In vitro synergy using time-kill assay was observed in 14 of 19 (74%) isolates tested; the synergistic effect was observed for almost all isolates for the combination of three drugs: colistin, amikacin, and tigecycline...
March 2017: Diagnostic Microbiology and Infectious Disease
Chi-Ching Chang, Yu-Sheng Chang, Wei-Sheng Chen, Yi-Hsuan Chen, Jin-Hua Chen
Studies on the clinical efficacy of influenza vaccination on patients with systemic lupus erythematosus (SLE) are scant. The present study compared the incidence of hospitalization, morbidity, and mortality in patients with SLE between cohorts with and without influenza vaccination. We used the Taiwan's insurance claims data between 2001 and 2012 for identifying annual adult patients with SLE with (N = 1765) and without (N = 8360) influenza vaccination. The incidence rate ratio and hazard ratio (HR) for morbidities and mortality were measured for the vaccine and nonvaccine cohorts...
December 2, 2016: Scientific Reports
Haijiao Jin, Wei Fang, Mingli Zhu, Zanzhe Yu, Yan Fang, Hao Yan, Minfang Zhang, Qin Wang, Xiajing Che, Yuanyuan Xie, Jiaying Huang, Chunhua Hu, Haifen Zhang, Shan Mou, Zhaohui Ni
BACKGROUND: Several studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients. METHODS: In this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included...
2016: PloS One
Ankita Tirath, Sandra Tadros, Samuel L Coffin, Kristina W Kintziger, Jennifer L Waller, Stephanie L Baer, Rhonda E Colombo, Lu Y Huber, Mufaddal F Kheda, N Stanley Nahman
Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea. Patients with end-stage renal disease (ESRD) may be at increased risk for CDI. Patients with ESRD with CDI have increased mortality, longer length of stay, and higher costs. The present studies extend these observations and address associated comorbidities, incidence of recurrence, and risk factors for mortality. We queried the United States Renal Data System (USRDS) for patients with ESRD diagnosed with CDI, and assessed for the incidence of infection, comorbidities, and mortality...
February 2017: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
Ilan I Maizlin, Michelle C Shroyer, Lena Perger, Mike K Chen, Elizabeth A Beierle, Colin A Martin, Scott A Anderson, Vincent E Mortellaro, David A Rogers, Robert T Russell
BACKGROUND: Recent advances in renal replacement therapy (RRT) have brought about a proliferation of dialysis in neonates (<30 d). This study aimed to assess morbidity and mortality after RRT initiation in this population. METHODS: Retrospective chart review of all patients between 2006 and 2014 requiring RRT initiated in the first 30 d of life was performed. RESULTS: A total of 49 patients were identified, of which 39 were boys and 10 were girls...
July 2016: Journal of Surgical Research
Darwin Tejera, Gino Limongi, Mauricio Bertullo, Mario Cancela
Ralstonia pickettii is a low-virulence gram-negative bacillus that may be associated with infections related to health care and may cause bacteremia. Ralstonia pickettii bacteremia is uncommon but is related to the contamination of medical products, mainly in immunodepressed patients. We present two cases of patients on chronic hemodialysis with Ralstonia pickettii bacteremia linked to contamination of the dialysis water. Similar cases have been published with links to intravenous fluid administration, medication ampules, and the use of extracorporeal oxygenation membranes, among other factors...
June 2016: Revista Brasileira de Terapia Intensiva
Bushra Jamil, Mohammad Tauseef Mukhtar Bokhari, Azhar Saeed, Mohammad Zahid Mukhtar Bokhari, Zakir Hussain, Tayabba Khalid, Habib Bukhari, Muhammad Imran, Shahid Ahmad Abbasi
OBJECTIVE: To determine the prevalence of bacteraemia in patients with chronic kidney disease, particularly those on dialysis and those who had had renal transplant, and to evaluate resistance among the isolated strains. METHODS: The cross-sectional study was conducted at Kidney Centre, Al-Sayyed Hospital, Rawalpindi, Pakistan, from June to December 2014. Samples that displayed positive growth were separated from the rest. The isolates were then identified and screened for extended spectrum beta lactamases and metallo beta lactamases production and other resistance mechanisms by phenotypic method...
June 2016: JPMA. the Journal of the Pakistan Medical Association
O O Okunola, J O Olaitan
BACKGROUND: Hemodialysis (HD) is the most common method of renal replacement therapy for patients with either acute kidney injury in the failure stage or end stage kidney failure in Nigeria. The number of dialysis centers in Nigeria has risen exponentially from 10 centers two decades ago to more than 120 centers in 2015. The number of patients needing renal replacement therapy in the country in the form of HD has also risen close to a projected 2000/year. The outcome from HD in Nigeria is poor as a result of a myriad of interwoven factors such as complications of cardiovascular diseases and suboptimal dialysis dose primarily due to economic factors...
July 2016: Nigerian Journal of Clinical Practice
Lars Skov Dalgaard, Mette Nørgaard, Johan Vestergaard Povlsen, Bente Jespersen, Søren Jensen-Fangel, Svend Ellermann-Eriksen, Lars Østergaard, Henrik Carl Schønheyder, Ole Schmeltz Søgaard
♦ BACKGROUND: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ OBJECTIVE: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. ♦ METHODS: Design: Observational cohort study. SETTING: Central and North Denmark regions...
November 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Sritika Thapa, Peter B Terry, Biren B Kamdar
BACKGROUND: Hemodialysis (HD) catheters are frequently inserted into the superior vena cava (SVC), and can lead to thrombotic complications. However, to our knowledge, HD catheter-related thrombosis leading to subsequent SVC syndrome, bacteremia, and pulmonary emboli has not been described. CASE PRESENTATION: A 28-year-old dialysis-dependent woman with IgA nephropathy developed facial swelling, head pressure, headache, nausea, dizziness and fever 6 weeks after right internal jugular (IJ) HD catheter placement...
April 23, 2016: BMC Research Notes
Lawrence P Park, Vivian H Chu, Gail Peterson, Athanasios Skoutelis, Tatjana Lejko-Zupa, Emilio Bouza, Pierre Tattevin, Gilbert Habib, Ren Tan, Javier Gonzalez, Javier Altclas, Jameela Edathodu, Claudio Querido Fortes, Rinaldo Focaccia Siciliano, Orathai Pachirat, Souha Kanj, Andrew Wang
BACKGROUND: Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE. METHODS AND RESULTS: Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method...
April 18, 2016: Journal of the American Heart Association
Michael Allon
Once hemodialysis patients have exhausted all option for a permanent vascular access in both upper extremities, they are often relegated at many dialysis centers to permanent catheter dependence with all its attendant complications, including infections, frequent dysfunction, and central vein stenosis. This commentary makes the case that thigh grafts are a far superior alternative to dialysis catheters in many of these patients. Technical graft failure may occur in some patients due to severe femoral artery calcification, but screening for calcification by ultrasound or computerized tomography can reduce the likelihood of a technical failure...
July 2016: Seminars in Dialysis
Namrata Krishnan
Hemodialysis catheter-related bacteremia (CRB) is the most common complication associated with catheter use in dialysis patients and portends a high morbidity and mortality. Current CDC and KDIGO guidelines recommend treating CRBs with systemic antibiotics in conjunction with catheter replacement, although the latter has limitations. Antibiotic lock solutions (ABLs) are very effective in both prevention and treatment of CRBs in hemodialysis patients and may be a preferred alternative to catheter replacement especially in patients where catheter salvage is a priority...
July 2016: Seminars in Dialysis
Sophie Collier, Hala Kandil, Enat Yewnetu, Jennifer Cross, Ben Caplin, Andrew Davenport
Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of "blunt" fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center practice, and the effect of both nasal screening and eradication and re-education and training programs. We audited the outcomes of 881 HD patients dialyzed between November 2009 and May 2012, divided into three groups: 175 dialyzing exclusively by central venous catheter (CVC), 478 exclusively by area needling AVF (AVF) and 219 by BH...
October 2016: Therapeutic Apheresis and Dialysis
Michelle M Boisen, Scott D Richard, Matthew P Holtzman, Robert P Edwards, Joseph L Kelley, Mohammad Haroon Choudry, David Bartlett, Marilyn Huang
BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) is often used to treat gastrointestinal malignancies and is of interest in epithelial ovarian cancer (EOC) given the propensity for intraperitoneal spread. The role of HIPEC in the treatment of gynecologic malignancies is not well defined. We sought to describe clinical characteristics and outcomes of our patient population treated with HIPEC. METHODS: IRB approval was obtained. Patients diagnosed with EOC and treated with HIPEC from January 2007 until December 2013 were identified using a prospectively maintained HIPEC database...
February 2016: Journal of Gastrointestinal Oncology
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