Silent infection in clotted hemodialysis access graft.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:152A 1997
Synthetic AV grafts have become the most common hemodialysis access in the dialysis population in the United States. These grafts have inferior survival compared to native AV fistulas and are more prone to infection, in which case surgical removal is usually necessary for clinical cure.
Clotted non-functioning grafts, often at more than one site, are present in large numbers of patients in any given dialysis unit.
The authors of this study evaluated the existence and clinical relevance of silent infection in clotted non-functioning grafts in 20 patients with fever and/or malaise, and clinical signs of sepsis when infection was not immediately localized to any other organ system. Indium Scan followed by graft removal was performed in 20 such patients and in 21 asymptomatic patients with clotted grafts.
Cultures of surgically recovered material and blood was done in all subjects. All symptomatic patients and 15 of the 20 controls had positive Indium scans and increased uptake in the region of the clotted graft. Surgical exploration showed purulent material in all 20 patients and 13 of the 15 Indium Scan positive controls. Blood cultures were positive in all patients and negative in all controls.
Comment: This is an extremely interesting study with clinical relevance, and it provides novel information. Clotted AV grafts were infected in 100% of symptomatic and 65% of asymptomatic patients. Indium scan localized infections with a sensitivity of 100% in both asymptomatic and symptomatic patients and had a specificity of 71% in asymptomatic patients.
This study raises the question whether all clotted AV grafts should be routinely removed or should surveillance Indium scans be performed to detect occult sepsis before these clotted grafts lead to bacteremia. It is also interesting to note that 25% of symptomatic patients and all asymptomatic patients had negative blood cultures thus suggesting that blood cultures would be useless for surveillance of asymptomatic individuals. (Shahab Arfeen, M.D., Valparaiso, IN)
To go back use the BACK button on your browser. Otherwise click on the desired link to this article below:
ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Vascular Access: graft/fistula