Candidemia in patients undergoing chronic hemodialysis

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The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection” Ourives et al (2016).

Abstract:

BACKGROUND: Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure.

AIMS: The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection.

METHODS: We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48h of hospital admission.

RESULTS: We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11-277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%).

CONCLUSIONS: CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality.

References:

Ourives, A.P., Gonçalves, S.S., Siqueira, R.A., Souza, A.C., Canziani, M.E., Manfredi, S.R., Correa, L. and Colombo, A.L. (2016) High rate of Candida deep-seated infection in patients under chronic hemodialysis with extended central venous catheter use. Revista Iberoamericana de Micología. February 10th. [Epub ahead of print].

doi: 10.1016/j.riam.2015.10.002.

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