Dementia and catheter dysfunction as under identified and documented risk factors for catheter related blood stream infections.
Al-Abid B, Sohaney R, Alamiri K, Kumbar L, Soi V, and Yee J. Dementia and catheter dysfunction as under identified and documented risk factors for catheter related blood stream infections. Am J Kidney Dis 2017; 69(4):A19-A19.
Am J Kidney Dis
Hemodialysis associated infections are a prominent cause of morbidity and mortality in patients with end-stage renal disease, second only to cardiovascular events, along with increased costs and hospitalization. Among vascular access types, central catheters have the highest risk of infection.
We conducted a retrospective study involving 70 patients with dialysis catheter related blood stream infection (CABSI) to identify certain risk factors for infection. After IRB approval, clinical variables collected included age, gender, race, prior tissue plasminogen activator use, number of prior catheter exchanges, and diagnosis of dementia. We compared the prevalence of those risk factors in the study population with that of the general population based on prior published data that shared the same data collection methodology.
A total 10 patients were diagnosed with dementia and the proportion of dementia was 14.29%. This was significantly higher than the general prevalence rate of 4% found on a cohort study of 16694 patients (p-value < 0.0001). There were 53 patients who had catheter replacements/exchanges due to catheter thrombosis, the average number of replacement/exchanges was 2.57 per patient. The catheter thrombosis rate of 75.7% was significantly higher than the general prevalence of catheter thrombosis of 51% based on a cohort of over 50000 patients (p-value < 0.0001).
Dementia and prior catheter dysfunction may be under recognized and under documented risk factors for CABSI. Patients with dementia may have higher rates of CABSI due to lack of proper care and hygiene technique. Improved identification may lead to earlier intervention which may ultimately lead to lower mortality, hospitalizations and cost of care. Prevalence based on chart review seems to be much lower than prevalence based on more objective methodology, and implementation of more sensitive methods for detection will likely result in better patient outcomes.