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Septicemia in Patients on Chronic Hemodialysis

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Grant support: During the course of this study Dr. Dobkin was supported by U.S. Public Health Service Training Grant T01-AI00405-05 from the National Institute of Allergy and Infectious Diseases.

This paper was presented in part at the 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Illinois, 1976.

▸Requests for reprints should be addressed to Neal H. Steigbigel, M.D.; Division of Infectious Diseases, Montefiore Hospital and Medical Center, 111 East 210th St.; Bronx, NY 10467

© 1978 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1978;88(1):28-33. doi:10.7326/0003-4819-88-1-28
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Bacterial sepsis, a major complication of chronic hemodialysis, is due mainly to infections of the vascular access site despite increasing use of internal fistulas. Sixty episodes of septicemia occurred in two chronic dialysis centers, with an incidence of 0.15 episodes of significant bacteremia per patient-dialysis-year in each. Forty-four of the 60 episodes were judged to be due to vascular access site infection by clinical, bacteriologic, and histologic criteria. Seventy percent (31 of 44) of the vascular access site-related episodes were due to staphylococci and 25% (11 of 44) to Gram-negative bacilli; nonvascular access site-related episodes were often due to transplant site infections caused by Gram-negative bacilli or streptococci. Mortality was about 18% in both vascular access site-related and nonrelated septic episodes. Bovine heterograft arteriovenous fistulas more often led to sepsis than did Brescia arteriovenous fistulas. Treatment with appropriate antibiotics was successful in most cases. Routine removal or ligation of the vascular access site was not necessary.





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