Infeccção da corrente sanguínea de pacientes hemodialisados – etiologia e fatores de risco para a mortalidade

Abstract

Introduction: Venous access infection is the second leading cause of mortality in patients with chronic kidney disease (CKD), most of which are caused by Gram-positive bacteria (GPB). Currently, an increase in bloodstream-related infections (BSI) by fungi and opportunistic Gram-negative bacteria (GNB) has been observed. Methods: A retrospective, cross-sectional and observational study was carried out in which the medical records of patients with CKD on hemodialysis, who had episodes of bloodstream infection from April 1, 2017 to April 1, 2022, were analyzed in order to determine the risk factors for ICS correlating them with the microbial agent and mortality. For mortality analysis, the bacteria were divided into two groups: pathogenic bacteria and opportunistic GNB. Results: A total of 161 records were verified. Of these, four had fungal infection and 157 patients had bacterial infection. A catheter was used in 79.6% of the cases. The average duration of catheter use was 3.0 months. Albumin was below 3.5 mg/ml in 34.2%, and hemoglobin ≤ 12 g/dl in 79.6%. When comparing the groups, there were differences regarding the use of catheter, the type of access, the time of use and the time of hemodialysis. Among the patients with positive blood cultures, 29.3% were due to opportunistic GNB, the most frequent being Burkholderia spp (50.0%), while among the pathogenic bacteria, it was Staphylococcus aureus. Conclusion: The longer the catheter use time, the time on hemodialysis and the presence of anemia, the higher the mortality. Patients with Artery Venous Fistula (AVF) were predominantly contaminated by opportunistic GNB.