BACKGROUND: Tunnelled catheters are used for dialysis in over 25% of haemodialysis (HD) patients and are a major risk factor for bacteraemia. HIV-positive patients may be at particularly increased risk of catheter-related bacteraemia (CRB) due to their immunocompromised state. The present case-controlled study compared catheter-related bacteraemia with HIV-positive and HIV-negative haemodialysis patients. METHODS: Using a prospective computerized vascular access database, we identified 33 HIV-positive haemodialysis patients who had a tunneled dialysis catheter placed during a 6.5-year period. Their catheter outcomes were compared with those observed in 55 age-, sex- and access date-matched control haemodialysis patients. RESULTS: The two groups were similar in terms of age, sex, diabetes, hypertension and peripheral vascular disease, but the HIV patients were more likely to be black (94 vs 76%, P=0.03). CRB occurred in 52% of the HIV patients and 49% of the controls (P=0.83). The median infection-free catheter survival was similar in HIV-positive and negative patients (165 vs 119 days, P=0.12). Among patients with CRB, the likelihood of a Gram-negative infection was similar in both groups (18 vs 30%, P=0.37). However, polymicrobial CRB was more likely in HIV patients (41 vs 15%, P=0.049). HIV-positive patients were more likely to be hospitalized for treatment of CRB than HIV-negative patients (29 vs 7%, P=0.05). CONCLUSION: CRB is equally likely in HIV-positive and control haemodialysis patients. However, CRB is likely to be more severe in HIV-positive patients, as judged from the greater likelihood of polymicrobial infection and of hospitalization.
BACKGROUND: Tunnelled catheters are used for dialysis in over 25% of haemodialysis (HD) patients and are a major risk factor for bacteraemia. HIV-positivepatients may be at particularly increased risk of catheter-related bacteraemia (CRB) due to their immunocompromised state. The present case-controlled study compared catheter-related bacteraemia with HIV-positive and HIV-negative haemodialysis patients. METHODS: Using a prospective computerized vascular access database, we identified 33 HIV-positive haemodialysis patients who had a tunneled dialysis catheter placed during a 6.5-year period. Their catheter outcomes were compared with those observed in 55 age-, sex- and access date-matched control haemodialysis patients. RESULTS: The two groups were similar in terms of age, sex, diabetes, hypertension and peripheral vascular disease, but the HIV patients were more likely to be black (94 vs 76%, P=0.03). CRB occurred in 52% of the HIV patients and 49% of the controls (P=0.83). The median infection-free catheter survival was similar in HIV-positive and negative patients (165 vs 119 days, P=0.12). Among patients with CRB, the likelihood of a Gram-negative infection was similar in both groups (18 vs 30%, P=0.37). However, polymicrobial CRB was more likely in HIV patients (41 vs 15%, P=0.049). HIV-positivepatients were more likely to be hospitalized for treatment of CRB than HIV-negative patients (29 vs 7%, P=0.05). CONCLUSION: CRB is equally likely in HIV-positive and control haemodialysis patients. However, CRB is likely to be more severe in HIV-positivepatients, as judged from the greater likelihood of polymicrobial infection and of hospitalization.
Authors: Gregory M Lucas; Michael J Ross; Peter G Stock; Michael G Shlipak; Christina M Wyatt; Samir K Gupta; Mohamed G Atta; Kara K Wools-Kaloustian; Paul A Pham; Leslie A Bruggeman; Jeffrey L Lennox; Patricio E Ray; Robert C Kalayjian Journal: Clin Infect Dis Date: 2014-09-17 Impact factor: 9.079