Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Nov 6, 2016; 5(6): 489-496
Published online Nov 6, 2016. doi: 10.5527/wjn.v5.i6.489
Bacteremia in hemodialysis patients
Masashi Suzuki, Nobuhiko Satoh, Motonobu Nakamura, Shoko Horita, George Seki, Kyoji Moriya
Masashi Suzuki, Nobuhiko Satoh, Motonobu Nakamura, Shoko Horita, Kyoji Moriya, Department of Internal Medicine, the University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-0033, Japan
Masashi Suzuki, Nobuhiko Satoh, Kyoji Moriya, Department of Infection Control and Prevention, the University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-0033, Japan
George Seki, Yaizu City Hospital, Yaizu, Shizuoka 425-8505, Japan
Author contributions: Suzuki M wrote the manuscript; Satoh N, Nakamura M, Horita S, Seki G and Moriya K performed the literature review and the final revision of the article.
Conflict-of-interest statement: No conflicts of interest are associated with this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masashi Suzuki, MD, PhD, Assistant Professor, Department of Infection Control and Prevention, the University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. mssuzuki-tky@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-58008796
Received: June 29, 2016
Peer-review started: July 1, 2016
First decision: August 5, 2016
Revised: September 5, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 6, 2016
Processing time: 127 Days and 4 Hours
Abstract

Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection (CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients.

Keywords: Bacteremia; Hemodialysis; Blood stream infection; Epidemiology; Infection control

Core tip: Infection is common in hemodialysis patients, who are at high risk for bacteremia. The use of a hemodialysis catheter is the most important risk factor for bacteremia. Improvement of standard infection control measures, including the reduction of catheter use, appropriate catheter care, patient and staff education, and hand hygiene could reduce bacteremia in hemodialysis patients.