RISK-FACTORS ASSOCIATED WITH PERMANENT ACCESS-SITE INFECTIONS IN CHRONIC-HEMODIALYSIS PATIENTS

OBJECTIVE: To determine the epidemiological risk factors associated wi th permanent access-site (PAS) infection in a population of chronic he modialysis patients. DESIGN: Retrospective cohort analysis. SETTING: H emodialysis unit of a 400-bed Department of Veterans' Affairs hospital . RESULTS: A cohort of 94 males (1,316 patient months) was studied. Fi fty-one PAS infections in 31 patients were observed. Six patients had two PAS infections, four patients had three infections, and two patien ts had four infections. Twenty-nine of the 31 patients with PAS infect ions were bacteremic at least once. Univariate analysis identified sev en factors significantly associated with PAS infection in this populat ion: location of PAS other than forearm, type of vascular access (poly tetrafluoroethylene [PTFE] versus endogenous arteriovenous [AV] fistul a), limited ambulatory status, residence in a nursing home, bacterial infection at a distant site, number of access-site revisions, and numb er of hospitalizations. Tn a logistic regression analysis, only graft type and number of PTFE graft revisions were associated independently with PAS infection. The odds ratio for PAS infection in PTFE grafts co mpared to endogenous AV fistula was 7.8; the odds ratio for PAS infect ion with each PTFE graft revision was 1.5. CONCLUSIONS: PAS infections were associated independently with the type of graft and the number o f PTFE graft surgical revisions (Infect Control Hosp Epidemiol 1997;18 :757-761).