Tunneled-cuffed catheter associated infections in hemodialysis patients who are seropositive for the human immunodeficiency virus

Infection rates in tunneled-cuffed catheters (TCC) are reported to be highe r in immunocompromised patients. The purpose of this study was to evaluate TCC-associated infection rates in patients with HIV infection (HIV+). Data were collected in 40 HIV+ patients and 31 controls (C), and in 118 TCC (HIV +, 58; C, 60) for 28,146 catheter days (HIVS, 16,227; C, 11,919). There wer e no significant differences in the TCC bacteremia rates (HIV+, 2.23 versus C, 2.53 per 1000 TCC days, P = NS) or in the TCC exit site infection rates (HIV+, 2.20 versus C, 2.24 per 1000 TCC days, P = NS) between the groups. The number of TCC removed due to infection was also similar, (HIV+ versus C : 17 versus 15%, P = NS). In the HIVS group, the association of hepatitis B surface antigenemia with TCC exit site infection was dependent on the hist ory of injection drug use. Black race was a significant risk factor for hig her TCC exit site infection rates, whereas prophylactic antibiotic use and high CD4 count were significantly associated with lower TCC exit site infec tion rates. None of the factors significantly predicted bacteremia rate in either group (HIV+ or C). In comparison to controls, HIV+ patients had a fi vefold increased risk of having a Gramnegative organism (P = 0.02) and a se venfold increased risk of a fungal isolate (P = 0.08), although the latter finding was not statistically significant. HIV infection is not a significa nt risk factor for TCC-associated infection but is associated with a higher prevalence of Gram-negative and fungal species.