Clinical consequences of infected arteriovenous grafts in hemodialysis patients

Arteriovenous (AV) graft infection is a serious adverse event in hemodialys is patients; however, there is little published literature describing its c onsequences. We identified prospectively all AV graft infections occurring at our institution during a 4.5-year period. We analyzed immediate complica tions, as well as long-term consequences, including the need for subsequent vascular-access procedures and duration of catheter-de pendent dialysis th erapy. Ninety graft infections were identified in 78 patients, yielding a r ate of 8.2 infections/100 graft-years. Patients with graft infection were m uch more likely to have a low serum albumin level (<3.5 g/dL) in the month preceding the infection compared with noninfected controls (73% versus 18%; P < 0.001). Infections occurred within 1 month of graft placement in 15%, at 1 to 12 months in 44%, and longer than 1 year from surgery in 41%. The p athogen was a gram-positive coccus in 97% of cases, particularly Staphyloco ccus aureus (60%) and Staphylococcus epidermidis (22%). The initial graft i nfection entailed hospitalization for a mean of 7.5 days. Eleven patients ( 12%) developed a total of 17 major complications, including death (5 patien ts), clinical sepsis requiring vasopressors (4 patients), septic arthritis (3 patients), epidural abscess (I patient), endocarditis (I patient), osteo myelitis (1 patient), myocardial infarction (1 patient), and cerebrovascula r accident (1 patient). After removal of an infected graft, patients were c atheter dependent for a median of 3.8 months. The duration of catheter depe ndence was less than 3 months in 36%, 3 to 6 months in 38%, 6 to 12 months in 14%, and greater than 1 year in 12%. During the period of catheter depen dence, patients required a mean of 9.7 access procedures, including graft r emoval (1.0 procedure), nontunneled dialysis catheters (4.4 procedures), tu nneled dialysis catheters (3.0 procedures), and new permanent accesses (1.4 procedures). In addition, patients averaged 0.85 episodes of bacteremia wh ile they were catheter dependent. In conclusion, graft infection results in substantial morbidity, prolonged dependence on dialysis catheters, and mul tiple vascular-access procedures. (C) 2001 by the National Kidney Foundatio n, Inc.