Article Figures & Data
Figures
- Figure 1.
Distribution of bacterial growth depending on the site of blood culture draw. *The individual blood culture is negative for bacterial growth but parts of the blood culture set (peripheral vein, arterial hub, venous hub and HD circuit) from which it came had bacterial growth. HD, hemodialysis.
Tables
- Table 1.
Patient characteristics at the time of suspected catheter–related bloodstream infection
Characteristics Events, n=100 Patients, n=62a Demographics Men (%) 47 (51.6) 35 (56.5) Age, yr, mean (range, median) 61 (26–88, 62) 61 (26–88, 62) Hemodialysis related Hemodialysis vintage, mo, mean (range, median) 71 (1–248, 54) 63 (1–248, 47) Central venous catheter, tunneled (%) 100 (100) 62 (100) Central venous catheter location (%) Right internal jugular 70 (70) 47 (75.8) Left internal jugular 24 (24) 12 (19.4) Right femoral 4 (4) 1 (1.6) Left femoral 1 (1) 1 (1.6) Right external jugular 1 (1) 1 (1.6) Central venous catheter vintage, mean (range, median) d,b 345 (1–1616, 172) 338 (3–1475, 245) Signs and symptoms on hemodialysis (%)c Events, n=124 Patients, n=74d Fever (>37.8°C on hemodialysis) 43 (34.7) 27 (36.4) Chills 12 (9.7) 9 (12.1) Suspected exit site infection 11 (8.9) 10 (13.5) Hypotension (SBP<100 mmHg or drop of SBP by >25 mmHg during hemodialysis) 20 (16.1) 9 (12.1) Nausea or vomiting 4 (3.2) 1 (1.4) Generalized pain 4 (3.2) 1 (1.4) Weakness 2 (1.6) 0 Feeling generally unwell 8 (6.5) 3 (4.1) Shortness of breath 2 (1.6) 1 (1.4) Undefined reason 18 (14.5) 13 (17.5) SBP, systolic BP.
↵a Value related to the first event in the patients with multiple episodes of suspected hemodialysis catheter–related bloodstream infections.
↵b Information on catheter vintage was not available for one patient, because catheter insertion occurred at another dialysis center.
↵c Multiple signs and symptoms per event are reported.
↵d Multiple signs and symptoms reported at the first event in the patients with multiple episodes of catheter–related bloodstream infections.
Bacterial Growth of Blood Culture Sets All Positive Partial Positive Contamination Negative n 27 6 12 55 Antibiotics given before BC 2 1 0 2 Time from dialysis start to BC draw, h:min, mean (range, median) 2:24 (0:03–7:10, 2:25) 1:33 (0:41–2:09, 1:33) 2:13 (0:26–4:57, 2:17) 2:22 (−0:04–9:02, 2:09) Time to sample cultivation, h:min, mean (range, median) 4:27 (0:05–17:07, 3:43) 8:54 (3:18–18:40, 8:11) 7:40 (1:46–20:16, 4:21) 5:48 (1:36–19:36, 4:56) Mean TTP, min Range, min Median, min Peripheral vein 1092 292–2502 856 HD circuit 966 163–2925 793 Arterial hub 1025 142–3909 777 Venous hub 947 280–2493 744 Mean DTTP, min Range, min Median, min Meeting Criteria of DTTP, % PV and HD circuit −107 −1505–795 −9 28 PV and arterial hub −106 −1504–2787 −4 33 PV and venous hub −176 −1710–1141 −11 29 HD circuit and arterial hub 35 −794–2799 −2 HD circuit and venous hub −33 −795–1241 −2 Arterial hub and venous hub −106 −2577–586 0 BC, blood culture; TTP, time to positivity; HD, hemodialysis; DTTP, differential time to positivity; PV, peripheral vein.
Organisma n % Time to Positivity Mean, h Range (Median) Gram-positive bacteria, total 86 22.6 Methicillin–sensitive Staphylococcus aureus 36 9.5 13.2 2.4–25.8 (12.7) Methicillin–resistant Staphylococcus aureus 4 1 11.4 8–13.5 (11.9) Coagulase-negative Staphylococcus 13 3.4 25.9 7.7–84.3 (20.9) Other Staphylococci 6 1.6 21 14.8–32.6 (17.35) Group B Streptococcus 4 1 10.1 9.6–11.6 (9.61) Enterococcus faecalis 8 2.1 16 7.9–38.1 (10.8) Otherb 15 3.9 34.3 10.8–78.8 (35.5) Gram-negative bacteria, total 28 7.4 Serratia marcescens 20 5.3 22.2 10.6–65.2 (16.2) Escherichia coli 4 1 11.8 11.7–12.6 (11.8) Proteus mirabilis 4 1 15.9 15.8–15.9 (15.9) No bacterial growth 266 70 Characteristics Successful Venipuncture No Peripheral Blood Obtained Total, n (%) 39 (75) 13 (25) BC obtained without problems, n (%) 30 (57.6) N/A BC obtained with problems, n (%) 9 (17.3) N/A Poor veins, n (%) 3a 4 (7.7) Collapsing veins, n 3a 0 iv Nurse to draw BC, n 3a 0 First attempt failed, n (%) 7a 4 (7.7) Second attempt failed, n 3a 3b Third attempt failed, n 0 3b Third attempt successful, n 3a N/A Patient refused venipuncture, n (%) N/A 5 +1b,c (9.6) Data on feasibility of obtaining blood cultures (BCs) from peripheral veins during hemodialysis. In the first year of the study, additional data were collected on the ease and barriers to obtaining a peripheral BC. N/A, not applicable.
↵a Multiple reasons for problems during venipuncture reported.
↵b Patients already accounted for in the first failed attempt.
↵c Five patients refused venipuncture immediately (and one after the first failed attempt).
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