Article Text

  1. R. Sullivan,
  2. R. Zaiden,
  3. D. Jones,
  4. I. Alexandraki,
  5. U. Bhatt,
  6. H. Vu,
  7. N. S. Nahman Jr
  1. Department of Medicine, University of Florida-Jacksonville, Jacksonville, FL


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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