Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters
Objectives: Tunneled-cuffed catheters (TCCs) are widely used in maintenance hemodialysis patients. However, microbial colonization in catheters increases the likelihood of developing various complications, such as catheter-related infection (CRI), catheter failure, hospitalization, and death. Identi...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-08-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.645539/full |
| _version_ | 1818644941371342848 |
|---|---|
| author | Xianhui Liang Xianhui Liang Yamin Liu Bohan Chen Ping Li Peixiang Zhao Zhangsuo Liu Zhangsuo Liu Pei Wang Pei Wang |
| author_facet | Xianhui Liang Xianhui Liang Yamin Liu Bohan Chen Ping Li Peixiang Zhao Zhangsuo Liu Zhangsuo Liu Pei Wang Pei Wang |
| author_sort | Xianhui Liang |
| collection | DOAJ |
| description | Objectives: Tunneled-cuffed catheters (TCCs) are widely used in maintenance hemodialysis patients. However, microbial colonization in catheters increases the likelihood of developing various complications, such as catheter-related infection (CRI), catheter failure, hospitalization, and death. Identification of the risk factors related to microorganism colonization may help us reduce the incidence of these adverse events. Therefore, a retrospective analysis of patients who underwent TCC removal was conducted.Methods: From a pool of 389 adult patients, 145 were selected for inclusion in the study. None of the patients met the diagnostic criteria for CRI within 30 days before recruitment. The right internal jugular vein was the unique route evaluated. The catheter removal procedure was guided by digital subtraction angiography. Catheter tips were collected for culture. Biochemical and clinical parameters were collected at the time of catheter removal.Results: The average age of this cohort was 55.46 ± 17.25 years. A total of 45/145 (31.03%) patients were verified to have a positive catheter culture. The proportions of gram-positive bacteria, gram-negative bacteria, and fungi were 57.8, 28.9, and 13.3%, respectively. History of CRI [odds ratio (OR) = 2.44, 95% confidence interval (CI) 1.09 to 5.49], fibrin sheath (OR = 2.93, 95% CI 1.39–6.19), white blood cell (WBC) count ≥5.9 × 109/l (OR = 2.31, 95% CI 1.12–4.77), moderate (OR = 4.87, 95% CI 1.61–14.78) or severe central venous stenosis (CVS) (OR = 4.74, 95% CI 1.16–19.38), and central venous thrombosis (CVT) (OR = 3.41, 95% CI 1.51–7.69) were associated with a significantly increased incidence of microbial colonization in a univariate analysis. Central venous disease (CVD) elevated the risk of microbial colonization, with an OR of 3.37 (1.47–7.71, P = 0.004). A multivariate analysis showed that both CVS and CVT were strongly associated with catheter microbial colonization, with ORs of 3.06 (1.20–7.78, P = 0.019) and 4.13 (1.21–14.05, P = 0.023), respectively. As the extent of stenosis increased, the relative risk of catheter microbial colonization also increased. In patients with moderate and severe stenosis, a sustained and significant increase in OR from 5.13 to 5.77 was observed.Conclusions: An elevated WBC count and CVD can put hemodialysis patients with TCCs at a higher risk of microbial colonization, even if these patients do not have the relevant symptoms of infection. Avoiding indwelling catheters is still the primary method for preventing CRI. |
| first_indexed | 2024-12-17T00:22:51Z |
| format | Article |
| id | doaj.art-886570a28a0a4d418251a3487526d66a |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-17T00:22:51Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-886570a28a0a4d418251a3487526d66a2022-12-21T22:10:31ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-08-01810.3389/fmed.2021.645539645539Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis CathetersXianhui Liang0Xianhui Liang1Yamin Liu2Bohan Chen3Ping Li4Peixiang Zhao5Zhangsuo Liu6Zhangsuo Liu7Pei Wang8Pei Wang9Blood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaResearch Institute of Nephrology, Zhengzhou University, Zhengzhou, ChinaBlood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaBlood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaBlood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaBlood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaBlood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaResearch Institute of Nephrology, Zhengzhou University, Zhengzhou, ChinaBlood Purification Center, Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaResearch Institute of Nephrology, Zhengzhou University, Zhengzhou, ChinaObjectives: Tunneled-cuffed catheters (TCCs) are widely used in maintenance hemodialysis patients. However, microbial colonization in catheters increases the likelihood of developing various complications, such as catheter-related infection (CRI), catheter failure, hospitalization, and death. Identification of the risk factors related to microorganism colonization may help us reduce the incidence of these adverse events. Therefore, a retrospective analysis of patients who underwent TCC removal was conducted.Methods: From a pool of 389 adult patients, 145 were selected for inclusion in the study. None of the patients met the diagnostic criteria for CRI within 30 days before recruitment. The right internal jugular vein was the unique route evaluated. The catheter removal procedure was guided by digital subtraction angiography. Catheter tips were collected for culture. Biochemical and clinical parameters were collected at the time of catheter removal.Results: The average age of this cohort was 55.46 ± 17.25 years. A total of 45/145 (31.03%) patients were verified to have a positive catheter culture. The proportions of gram-positive bacteria, gram-negative bacteria, and fungi were 57.8, 28.9, and 13.3%, respectively. History of CRI [odds ratio (OR) = 2.44, 95% confidence interval (CI) 1.09 to 5.49], fibrin sheath (OR = 2.93, 95% CI 1.39–6.19), white blood cell (WBC) count ≥5.9 × 109/l (OR = 2.31, 95% CI 1.12–4.77), moderate (OR = 4.87, 95% CI 1.61–14.78) or severe central venous stenosis (CVS) (OR = 4.74, 95% CI 1.16–19.38), and central venous thrombosis (CVT) (OR = 3.41, 95% CI 1.51–7.69) were associated with a significantly increased incidence of microbial colonization in a univariate analysis. Central venous disease (CVD) elevated the risk of microbial colonization, with an OR of 3.37 (1.47–7.71, P = 0.004). A multivariate analysis showed that both CVS and CVT were strongly associated with catheter microbial colonization, with ORs of 3.06 (1.20–7.78, P = 0.019) and 4.13 (1.21–14.05, P = 0.023), respectively. As the extent of stenosis increased, the relative risk of catheter microbial colonization also increased. In patients with moderate and severe stenosis, a sustained and significant increase in OR from 5.13 to 5.77 was observed.Conclusions: An elevated WBC count and CVD can put hemodialysis patients with TCCs at a higher risk of microbial colonization, even if these patients do not have the relevant symptoms of infection. Avoiding indwelling catheters is still the primary method for preventing CRI.https://www.frontiersin.org/articles/10.3389/fmed.2021.645539/fulltunneled cuffed cathetercatheter-related infectioncentral venous stenosiscentral venous thrombosismicrobial colonization |
| spellingShingle | Xianhui Liang Xianhui Liang Yamin Liu Bohan Chen Ping Li Peixiang Zhao Zhangsuo Liu Zhangsuo Liu Pei Wang Pei Wang Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters Frontiers in Medicine tunneled cuffed catheter catheter-related infection central venous stenosis central venous thrombosis microbial colonization |
| title | Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters |
| title_full | Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters |
| title_fullStr | Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters |
| title_full_unstemmed | Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters |
| title_short | Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters |
| title_sort | central venous disease increases the risk of microbial colonization in hemodialysis catheters |
| topic | tunneled cuffed catheter catheter-related infection central venous stenosis central venous thrombosis microbial colonization |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.645539/full |
| work_keys_str_mv | AT xianhuiliang centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT xianhuiliang centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT yaminliu centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT bohanchen centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT pingli centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT peixiangzhao centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT zhangsuoliu centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT zhangsuoliu centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT peiwang centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters AT peiwang centralvenousdiseaseincreasestheriskofmicrobialcolonizationinhemodialysiscatheters |