Hemodialysis (HD) patients with double-lumen vascular access catheters (D-VAC) are at substantial risk for bacteremia. In this regard, we have shown a rising incidence of gram-negative bacteremia in these patients from 2000-2004 (Alexandraki et al. J Am Soc Nephrol, in press). In a subset analysis of this cohort, 28% were also seropositive for hepatitis C (HepC), suggesting an association between the two infections. To further address this question, we identified a historical control group by reviewing the available medical records of 111 HD patients with D-VAC and bacteremia who received dialysis treatments at our institution between 2002 and 2004. In addition, the charts of 39 patients currently on dialysis and with a D-VAC were reviewed. For these 150 patients, demographics included age 48 6 3.9 years (mean 6 SEM), 47% male, and 81% African American. For this study all charts were screened for HepC serologies and a history of bacteremia. 146 patients met these entry criteria for the study. In this group, 131 patients (107 historical controls and 24 current patients) (90%) had a history of documented bacteremia (BAC), and 15 (10%) had never had an episode (CON). When compared to CON, BAC had a significantly higher incidence of HepC seropositivity (28 vs 7%, respectively, p = .042, chi square). When the historical controls were sorted by offending organism (gram-negative [GNO], gram positive [GPO], or polymicrobial [POLY]), there were no differences in the incidence of HepC seroconversion (9/32 [23%], 13/40 [27%], and 10/35 [24%] for GNO, GPO, and POLY, respectively). When sorted by offending organism, HIV seroconversion status did not differ among historical controls (0, 2, and 2% for GNO, GPO, and POLY, respectively). There were insufficient data in CON patients for an analysis of HIV status.
Conclusion HepC seroconversion rates are higher in HD patients with D-VAC and bacteremia than in patients never experiencing a bacteremic episode. These data raise questions about possible immunomodulatory effects of HepC that may affect susceptibility to bacteremia. Showing a pathophysiologic role for HepC in D-VAC-associated bacteremia may influence approaches to HepC management and affect clinical decision making in patients with D-VAC.
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