1. Risk of Catheter-Related Bloodstream Infection in Elderly Patients on Hemodialysis
- Author
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Kimone M. James, Nicholas S. Tuttle, James E. Yates, Greg Russell, Barry I. Freedman, Mariana Murea, John M. Burkart, Anthony J. Bleyer, and Graham V. Byrum
- Subjects
Adult ,Male ,Catheterization, Central Venous ,medicine.medical_specialty ,Time Factors ,Adolescent ,Epidemiology ,medicine.medical_treatment ,Population ,Critical Care and Intensive Care Medicine ,Lower risk ,Risk Assessment ,Young Adult ,Catheters, Indwelling ,Renal Dialysis ,Risk Factors ,North Carolina ,medicine ,Central Venous Catheters ,Humans ,Catheter Site ,education ,Dialysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Transplantation ,education.field_of_study ,business.industry ,Incidence ,Hazard ratio ,Age Factors ,Editorials ,Retrospective cohort study ,Middle Aged ,Surgery ,Catheter ,Nephrology ,Catheter-Related Infections ,Multivariate Analysis ,Linear Models ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business - Abstract
Background and objectives Elderly patients require tunneled central vein dialysis catheters more often than younger patients. Little is known about the risk of catheter-related bloodstream infection in this population. Design, setting, participants, & measurements This study identified 464 patients on hemodialysis with tunneled central vein dialysis catheters between 2005 and 2007 and excluded patients who accrued ,21 catheter-days during this period. Outpatient and inpatient catheter-related bloodstream infection data were collected. A Cox proportional hazards regression analysis adjustingfor sex,ancestry, comorbidites, dialysis vintage, dialysis unit, immunosuppression, initial catheter site, and first antimicrobial catheter lock solution was performed for risk of catheter-related bloodstream infection between nonelderly (18–74 years) and elderly ($75 years) patients. ResultsIn total, 374 nonelderly and 90 elderly patients with mean (SD) ages of 54.8 (12.3) and 81.3 (4.9) years and dialysis vintages of 1.8 (3.3) and 1.5 (2.9) years (P=0.47), respectively, were identified. Mean at-risk catheter-days were 272 (243) in nonelderly and 318 (240) in elderly patients. Between age groups, there were no significant differences in initial catheter site, type of catheter lock solution, or microbiology results. A total of 208 catheterrelated bloodstream infection events occurred (190 events in nonelderly and 18 events in elderly patients), with acatheter-related bloodstreaminfectionincidence per 1000 catheter-daysof1.97(4.6)innonelderlyand0.55 (1.6) in elderly patients (P,0.001). Relative to nonelderly patients, the hazard ratio for catheter-related bloodstream infection in the elderly was 0.33 (95% confidence interval, 0.20 to 0.55; P,0.001) after multivariate analysis. Conclusion Elderly patients on hemodialysis using tunneled central vein dialysis catheters are at lower risk of catheter-related bloodstream infection than their younger counterparts. For some elderly patients, tunneled central vein dialysis catheters may represent a suitable dialysis access option in the setting of nonmaturing arteriovenous fistulae or poorly functioning synthetic grafts. Clin J Am Soc Nephrol 9: 764–770, 2014. doi: 10.2215/CJN.07710713
- Published
- 2014