Bacteremia associada a acessos vasculares em clientes em hemodiálise ambulatorial

Abstract

INTRODUCTION: Hemodialysis (HD) is the most commonly used renal replacement therapy (RRT) in Brazil in patients with chronic kidney disease (CKD). For this to happen, vascular access is required, which may be a double lumen catheter or through an arteriovenous fistula (AVF). It is common at the beginning of dialysis treatment the use of double lumen catheter until AVF is made or matured. Vascular accesses act as risk factors for the occurrence of healthcare-related infection, among which bacteremia has a high mortality rate. OBJECTIVE: To estimate the occurrence of bacteremia associated with the use of double lumen catheter and / or AVF in outpatients on hemodialysis. METODOLOGY: Retrospective, analytical and exploratory cohort study with quantitative, correlational and comparative approach, conducted with individuals undergoing outpatient hemodialysis, from January 2009 to January 2019, at the Hospital de Uberlândia Clinics, Federal University of Uberlândia (HCU-UFU). RESULTS: We analyzed 23 patients totaling 59 bacteremias, mostly male, all with more than one comorbidity. The incidence densities of temporary catheter-related, long-term catheters and arteriovenous fistula-related bacteremias were 1.3 / 1000 catheter-day, 0.54 / 1000 catheter-day and 0.12 / 1000 catheter-day, respectively. . The most commonly isolated microorganisms were gram- positive Staphylococcus aureus and Staphylococcus epidermidis. CONCLUSION: Bacteremia in outpatient hemodialysis is more frequent in patients with temporary catheter-type vascular access. The main microorganisms found are Staphylococcus aureus, Staphylococcus epidermides and Escherichia coli with resistance to more than one antimicrobial class. The incidence rate of catheter infections is considered low compared to the rates found in the literature, and this shows the effectiveness of preventive actions to reduce bacteremia and, consequently, for patient safety.