Outbreak of Hemodialysis Vascular Access Site Infections Related to Malfunctioning Permanent Tunneled Catheters: Making the Case for Active Infection Surveillance

2002 ◽  
Vol 23 (9) ◽  
pp. 538-541 ◽  
Author(s):  
Elizabeth L. Hannah ◽  
Kurt B. Stevenson ◽  
Connie A. Lowder ◽  
Michael J. Adcox ◽  
Robert L. Davidson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infection Rate ◽  
Vascular Access ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Infectious Complications ◽  
Routine Activity ◽  
Access Site ◽  
Integrated Network ◽  
Infection Surveillance

Objective:To describe an outbreak of infections with permanent cuffed hemodialysis catheters recognized through ongoing surveillance and related to a specific malfunctioning permanent catheter.Design:The outbreak was suspected from the results of prospective infection surveillance and confirmed by a retrospective cohort study using medical records for patients receiving dialysis between April 1,1999, and March 31, 2000.Setting:Integrated network of six outpatient hemodialysis facilities in southern Idaho and eastern Oregon.Patients:Outpatients receiving long-term hemodialysis.Results:During the 18 months prior to the outbreak, the overall infection rate was 4.1 infections per 1,000 dialysis sessions with a catheter rate of 8.9 per 1,000 dialysis sessions. During the 7 months of the outbreak, the overall rate increased to 5.8 per 1,000 dialysis sessions, whereas the catheter rate increased to 18.1 per 1,000 dialysis sessions. Reports of malfunctioning “Brand A” catheters prompted discontinuation of their placement. A manufacturer recall occurred in April 2000. During the 14 months after the outbreak, the overall infection rate decreased to 3.3 per 1,000 dialysis sessions and the catheter rate to 10.8 per 1,000 dialysis sessions. A 12-month retrospective cohort study recognized 96 patients with an identifiable catheter brand and 48 infections. Of these, 27 (56%) occurred in patients with Brand A catheters. The relative risk for infection when compared with other catheter brands was 1.96 (95% confidence interval, 1.32 to 2.92; P < .001).Conclusions:Ongoing infection surveillance in hemodialysis facilities can identify specific device-related outbreaks of infections and promote interventions to reduce infectious complications and promote patient safety. Surveillance for vascular access site infections is recommended as a routine activity in hemodialysis facilities.

scholarly journals MP661ARTERIOVENOUS FISTULA AND ARTERIOVENOUS GRAFT FOR VASCULAR ACCESS IN HAEMODIALYSIS - A RETROSPECTIVE COHORT STUDY

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii674-iii674
Author(s):  
Rachele Escoli ◽  
Ivan Luz ◽  
Hernani Gonçalves ◽  
Paulo Santos ◽  
Ana Vila Lobos
Keyword(s):  
Cohort Study ◽  
Vascular Access ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Arteriovenous Graft

scholarly journals Burden of cytomegalovirus reactivation post kidney transplant with antithymocyte globulin use in Thailand: A retrospective cohort study

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1568 ◽  
Author(s):  
Maria N. Chitasombat ◽  
Siriorn P. Watcharananan
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Antithymocyte Globulin ◽  
Graft Loss ◽  
Infectious Complications ◽  
Inpatient Setting ◽  
Cost Of Treatment ◽  
Duration Of Hospitalization ◽  
Cmv Reactivation

Background: Cytomegalovirus (CMV) is an important cause of infectious complications after kidney transplantation (KT), especially among patients receiving antithymocyte globulin (ATG). CMV infection can result in organ dysfunction and indirect effects such as graft rejection, graft failure, and opportunistic infections. Prevention of CMV reactivation includes pre-emptive or prophylactic approaches. Access to valganciclovir prophylaxis is limited by high cost. Our objective is to determine the burden and cost of treatment for CMV reactivation/disease among KT recipients who received ATG in Thailand since its first use in our center. Methods: We conducted a single-center retrospective cohort study of KT patients who received ATG during 2010-2013. We reviewed patients’ characteristics, type of CMV prophylaxis, incidence of CMV reactivation, and outcome (co-infections, graft function and death). We compared the treatment cost between patients with and without CMV reactivation. Results: Thirty patients included in the study had CMV serostatus D+/R+. Twenty-nine patients received intravenous ganciclovir early after KT as inpatients. Only three received outpatient valganciclovir prophylaxis. Incidence of CMV reactivation was 43%, with a median onset of 91 (range 23-1007) days after KT. Three patients had CMV end-organ disease; enterocolitis or retinitis. Infectious complication rate among ATG-treated KT patients was up to 83%, with a trend toward a higher rate among those with CMV reactivation (P = 0.087). Patients with CMV reactivation/disease required longer duration of hospitalization (P = 0.018). The rate of graft loss was 17%. The survival rate was 97%. The cost of treatment among patients with CMV reactivation was significantly higher for both inpatient setting (P = 0.021) and total cost (P = 0.035) than in those without CMV reactivation. Conclusions: Burden of infectious complications among ATG-treated KT patients was high. CMV reactivation is common and associated with longer duration of hospitalization and higher cost.

scholarly journals What is the Best Setting for Receiving Dialysis Vascular access Repair and Maintenance Services?

2017 ◽  
Vol 18 (6) ◽  
pp. 473-481 ◽  
Author(s):  
Audrey M. El-Gamil ◽  
Al Dobson ◽  
Nikolay Manolov ◽  
Joan E. DaVanzo ◽  
Gerald A. Beathard ◽  
...  
Keyword(s):  
United States ◽  
Organizational Culture ◽  
Cohort Study ◽  
Patient Outcomes ◽  
Vascular Access ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Data System ◽  
Propensity Matching ◽  
Annual Mortality

Introduction Advances in dialysis vascular access (DVA) management have changed where beneficiaries receive this care. The effectiveness, safety, quality, and economy of different care settings have been questioned. This study compares patient outcomes of receiving DVA services in the freestanding office-based center (FOC) to those of the hospital outpatient department (HOPD). It also examines whether outcomes differ for a centrally managed system of FOCs (CMFOC) compared to all other FOCs (AOFOC). Methods Retrospective cohort study of clinically and demographically similar patients within Medicare claims available through United States Renal Data System (USRDS) (2010-2013) who received at least 80% of DVA services in an FOC (n = 80,831) or HOPD (n = 133,965). Separately, FOC population is divided into CMFOC (n = 20,802) and AOFOC (n = 80,267). Propensity matching was used to control for clinical, demographic, and functional characteristics across populations. Results FOC patients experienced significantly better outcomes, including lower annual mortality (14.6% vs. 17.2%, p<0.001) and DVA-related infections (0.16 vs. 0.20, p<0.001), fewer hospitalizations (1.65 vs. 1.91, p<0.001), and lower total per-member-per-month (PMPM) payments ($5042 vs. $5361, p<0.001) than HOPD patients. CMFOC patients had lower annual mortality (12.5% vs. 13.8%, p<0.001), PMPM payments (DVA services) ($1486 vs. $1533, p<0.001) and hospitalizations ($1752 vs. $1816, p<0.001) than AOFOC patients. Conclusions Where nephrologists send patients for DVA services can impact patient clinical and economic outcomes. This research confirmed that patients who received DVA care in the FOC had better outcomes than those treated in the HOPD. The organizational culture and clinical oversight of the CMFOC may result in more favorable outcomes than receiving care in AOFOC.

scholarly journals Topical vancomycin reduces the cerebrospinal fluid shunt infection rate: A retrospective cohort study

PLoS ONE ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. e0190249 ◽  
Author(s):  
Erik J. van Lindert ◽  
Martine van Bilsen ◽  
Michiel van der Flier ◽  
Eva Kolwijck ◽  
Hans Delye ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cohort Study ◽  
Infection Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Shunt Infection ◽  
Cerebrospinal Fluid Shunt ◽  
Shunt Infection Rate
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