Hemodialysis infection

Delcour C, Bruninx G IncompatibiUty of contrast medium and trisodium citrate. Car-diovasc Intervent Radiol 2013 36 237-238. Camins BC, Richmond AM, Dyer KL, et al Crossover intervention trial evaluating the efficacy of a chlorhexidine-impregnated sponge in reducing catheter-related bloodstream infections among patients undergoing hemodialysis. Infect Control Hosp Epidemiol 2010 31 1118-1123. 

Lok CE, et al Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol 2003 14 169-179. 

Lee SC, et al An outbreak of methicillin-re-sistant Staphylococcus aureus infections related to central venous catheters for hemodialysis. Infect Control Hosp Epidemiol 2004 25 678-684. 

Infections in hemodialysis patients may be related to the choice of membranes, the complement-activating membranes being more deleterious. 

Infections are an important cause of morbidity and mortality in patients receiving hemodialysis. The cause of infection is usually related to organisms found on the skin, namely Staphylococcus epidermidis and S. aureus. Other organisms have also been found to cause access-related infections. The greatest risk to patients receiving hemodialysis is the development of... 

Blood cultures should be obtained for any patient receiving hemodialysis who develops a fever. Nonpharmacologic management of infections involves preventive measures with sterile technique, proper disinfection, and minimizing the use and duration of venous catheters for hemodialysis access. 

Pharmacologic management of infections should cover the gram-positive organisms that most frequently cause access-related infections. Patients who have positive blood cultures should receive treatment tailored to the organism isolated. Preventive measures for access-related infections include mupirocin at the exit site and povidone-iodine ointment. The recommendations of the NKF for treatment of infections associated with hemodialysis are listed in Table 23-9. 

Evaluate the patient for complications associated with dialysis. Does the patient develop hypotension or cramps during hemodialysis Does the patient have symptoms consistent with peritonitis or a catheter infection ... 

Patients with a history of recent antimicrobial use may have altered normal flora or harbor resistant organisms. If a patient develops a new infection while on therapy, fails therapy, or has received antimicrobials recently, it is prudent to prescribe a different class of antimicrobial because resistance is likely. Previous hospitalization or health care utilization (e.g., residing in a nursing home, hemodialysis, and outpatient antimicrobial therapy) are risk factors for the acquisition of nosocomial pathogens, which are often resistant organisms. 

Pneumonia is inflammation of the lung with consolidation. The cause of the inflammation is infection, which can result from a wide range of organisms. There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. Patients who develop pneumonia in the outpatient setting and have not been in any health care facilities, which include wound care and hemodialysis clinics, have community-acquired pneumonia (CAP). Aspiration is of either oropharyngeal or gastrointestinal contents. Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission.1,2 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 to 72 hours before the onset of... 

The most commonly used screening method for HIV is an enzyme-linked immunosorbent assay, which detects antibodies against HIV-1 and is both highly sensitive and specific. False positives can occur in multiparous women in recent recipients of hepatitis B, HIV, influenza, or rabies vaccine following multiple blood transfusions and in those with liver disease or renal failure, or undergoing chronic hemodialysis. False negatives may occur if the patient is newly infected and the test is performed before antibody production is adequate. The minimum time to develop antibodies is 3 to 4 weeks from initial exposure. 

Medea indications Persons with end-stage renal disease, including patients receiving hemodialysis persons seeking evaluation or treatment for a sexually transmitted disease (STD) persons with HIV infection and persons with chronic liver disease. 

In patients with severe renal failure, give 500 mg, 1 or 2 g initially. The maintenance dose should be 25% of the usual initial dose given at the usual fixed interval of 6, 8, or 12 hours. For serious or life-threatening infections, in addition to the maintenance doses, give 12.5% of the initial dose after each hemodialysis session. 

Pharyngitis or tonsillitis PO 300 mg ql2h for 5-10 days or 600 mg q24h for 10 days. Uncomplicated skin or skin-structure infections PO 300 mg q 12h for 10 days Dosage in renal impairment For patients with creatinine clearance less than 30 ml/min, dosage is 300 mg/day as single daily dose. For hemodialysis patients, dosage is 300 mg or 7 mg/kg/dose every other day. 

Usual dosage, 3-6 mg/kg/day in divided doses q8h or 4-6.6 mg/kg once a day. Hemodialysis IV, IM 0.5-0.7mg/kg/dose after dialysis. Intrathecal 4-8 mg/day. Superficial eye infections Ophthalmic Ointment Usual dosage, apply thin strip to conjunctiva 2-3 times a day. Ophthalmic Solution Usual dosage, 1-2 drops q2-4h up to 2 drops/hr. 

Mecfianism of Action An anti-infective that interferes with nuclear metabolism and incorporation of nucleotides, inhibiting DNA, RNA, phospholipid, and protein synthesis, THerapeutic Effect Produces antibacterial and ID-antiprotozoal effects, Pfiarmacokinetics Well absorbed after IM administration minimally absorbed after inhalation. Widely distributed. Primarily excreted in urine. Minimally removed by hemodialysis, Half-life 6,5 hr (increased in impaired renal function). 

Oral bioavailability exceeds 80% and is not food-dependent. Peak serum levels after standard doses are 1.5 0.5 g/mL, and protein binding is less than 36%. In children, the mean CSF plasma ratio of lamivudine was 0.2. Mean elimination half-life is 2.5 hours, while the intracellular half-life of the active 5 -triphosphate metabolite in HIV-1-infected cell lines is 10.5-15.5 hours. The majority of lamivudine is eliminated unchanged in the urine, and the dose should be reduced in patients with renal insufficiency or low body weight (Table 49-3). No supplemental doses are required after routine hemodialysis. 

Besides glucose, other analytes of clinical value can be possibly quantified by noninvasive spectral analysis. In vivo concentrations of lactate and urea are examples. The concentration of lactate in blood is used clinically to follow intensive care treatments, to identify cardiac or liver failure, to determine hypoxia of tissues from atherosclerosis, and to detect bacterial infection. In vivo urea levels are valuable for optimizing hemodialysis treatments and tracking the accumulation of toxins for people with end-stage renal failure or recent kidney transplant recipients. 

It is seen that the basal values increase in the order fluoroethy lene-polypropy lene < polyacrylonitrile < polyetherpolycarbonate < regenerated cellulose which was interpreted as a sign of increasing cell-polymer interaction. (The fluorinated reference polymer is assumed to be compatible with the cells.) When the functional activity of the cells was tested by stimulation with zymosan, the values varied in the reverse order, i.e., the interactions are harmful as it will lead to a decreased ability of the cells to phagocytoze. (It should be noted that uremic patients on hemodialysis are particularly prone to infections.) Another interesting use of... 

The treatment for VHP infection is mainly supportive, including intravenous fluids and electrolyte replacement. Hemodialysis, invasive monitoring, and vasopressor therapy may also be needed. Care should be taken... 

Hutin, Y.XF., Goldstein, S.T., Varma, XK., Odair, XB., Mast, E.E., Shapiro, C.N., Alter, M.X An outbreak of hospital-acquired hepatitis B virus infection among patients receiving chronic hemodialysis. Inf. Contr. Hosp. Epid. 1999 20 731 -735... 

Delarocque-Astagneau, E., Baffoy, N., Thiers, V., Simon, N., de Valk, H., Laperche, S., Courouce, A.M., Astagneau, R, Buisson, C., Desen-cios, J.C, Outbreak of hepatitis C virus infection in a hemodialysis unit Potential transmission by the hemodialysis machine Infect. Contr. Hosp. Epidem. 2002 23 328—334... 

M., Gruewald, K., Greenberg, H.B. Hepatitis G virus infection in hemodialysis patients and the effects of interferon treatment. Amer. X Gastroenterol. 1997 92 1986-1991... 

Gad, A., Tanaka, ., Orii, K., Rokuhara, A., Nooman, Z., 1-Hamid-Serwah, A., El-Sherif, A., El-Essawy, M., Yoshizawa, K., Kiyosawa, K. Clinical significance of TT virus infection in maintenance hemodialysis patients of an endemic area for hepatitis C infection. Hepatol. Res. 2002 22 13-19... 

A 73-year-old man with acute respiratory failure, presumed to be secondary to amiodarone toxicity, developed sepsis and acute renal insufficiency, and required intermittent hemodialysis. Following a Herpes simplex labialis infection he was treated with oral aciclovir (400 mg tds). The next day he became sleepy, disoriented, and agitated. Over the next 48 hours his neurological condition deteriorated and he responded to pain... 

Suassuna JH, Machado RD, Sampaio JC, Leite LL, Villela LH, Ruzany F, Souza ER, Moraes JR. Active cytomegalovirus infection in hemodialysis patients receiving donor-specific blood transfusions under azathioprine coverage. Transplantation 1993 56(6) 1552-4. 

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