A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

• Published in: Medical principles and practice 2018-01, Vol.27 (4), p.337-342
• Main Authors: Ramadan, Moustapha Ahmed, Hebbar, Gautam
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Ambulatory Care Facilities; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - therapeutic use; Antimicrobial agents; Catheter-Related Infections - epidemiology; Catheter-Related Infections - microbiology; Catheters; Central Venous Catheters - microbiology; Clinical medicine; Cross Infection - epidemiology; Cross Infection - microbiology; Diabetes; Disease control; Disease prevention; Drug Utilization; Epidemiology; Fistula; Gram-Negative Bacteria - isolation & purification; Gram-Negative Bacterial Infections - epidemiology; Gram-Positive Bacteria - isolation & purification; Gram-Positive Bacterial Infections - epidemiology; Health surveillance; Hemodialysis; Hospitals; Humans; Inflammation; Kidney diseases; Kuwait - epidemiology; Medical records; Original Paper; Patients; Peritoneal dialysis; Public health; Renal Dialysis - adverse effects; Renal Dialysis - statistics & numerical data; Retrospective Studies; Staphylococcus infections; Vascular Access Devices - microbiology
• ISSN: 1011-7571; 1423-0151
• DOI: 10.1159/000486595

Objective: To determine the difference in the rates of dialysis events stratified by vascular access type and to describe the microbiological profile and sensitivity patterns of positive blood cultures over a 3-year period. Subjects and Methods: The dialysis event data of 10,751 chronic hemodialysis patients collected from March 2013 to February 2016 at an outpatient dialysis unit in Kuwait were reviewed. The dialysis events studied were: intravenous (IV) antimicrobial use, a positive blood culture, and signs of inflammation at the vascular access site. Dialysis event rates were stratified by the type of vascular access used for the dialysis, i.e., fistula, graft, and tunneled/nontunneled central line. Rates were expressed per 100 patient-months. Results: The overall dialysis event rate was (10.7/100 patient-months). The rate of IV antimicrobial use was higher (12.53/100 patient-months) in patients with tunneled central lines than in all other vascular access types (10.29/100 patient-months). Positive blood culture and inflammation at the vascular access site were highest in patients with nontunneled central lines (1.65 and 1.54/100 patient-months, respectively) when compared to those with other types of vascular access. Gram-negative rod isolates were predominant in patients with central lines (n = 35; 46.67%); however, common skin commensals and gram-negative rods were also identified in patients with fistula or graft (n = 4; 44.45%). Conclusion: Dialysis event rates were higher among patients with tunneled or nontunneled central lines than in patients with fistula or graft. Gram-negative rods were the most commonly isolated microbial group.