A Retrospective Analysis of Catheter-Related Infections in a Hemodialysis Population
Bibliographic record
Abstract
ABSTRACT Objectives: To promote optimal use of vancomycin and reduce selective pressures for development of vancomycin-resistant enterococci in our hemodialysis units, we conducted a retrospective study to a.) characterize catheter-related infections (CRI) in our hemodialysis population, and b.) review vancomycin usage to treat these infections. Methods: A retrospective analysis of hospital and dialysis charts was performed for patients receiving chronic hemodialysis (> l month) in our University-affiliated teaching hospital. Data was collected by a single investigator for all episodes of suspected or documented catheter-related infection (bacteremia) for the 24-month period beginning May 1, 1994 and ending April 30, 1996. Management of each confirmed CRI was also recorded. Results: Of 135 suspected CRIs, 74 were confirmed using Centre for Disease Control criteria. Permanent and temporary subclavian catheters had the highest rate of infection. Pus at the catheter site was most commonly associated with confirmed CRI (75%). Of the 74 confirmed CRIs, the most commonly isolated pathogens were S. epidermidis (47/74, 63.5%) and S. aureus (23/74, 31%). Twenty-six percent of confirmed CRIs involved S. epidermidis or S. aureus isolates that were resistant to all antibiotics commonly-used to eradicate gram-positive organisms, e.g. cefazolin, cloxacillin, clindamycin, but remained sensitive to vancomycin. Conclusions: After one empiric dose of vancomycin, cefazolin should be considered for the remainder of therapy in all episodes where in vitro susceptibility of the organism to cefazolin has been established. RESUME Objectifs : Promouvoir l'usage optimal de la vancomycine et reduire les risques selectifs d'apparition d'enterocoques resistants a la vancomycine dans nos unites d'hemodialyse. Nous avons mene une etude retrospective pour a) etablir les caracteristiques des infections liees a l'utilisation d'un catheter (CRI) dans notre population d'hemodialyses, et b) evaluer l'utilisation de la vancomycine pour traiter ces infections. Methode : Une analyse retrospective des dossiers hospitaliers et d'hemodialyse a ete realisee pour les patients sous hemodialyse chronique (> 1 mois) dans notre centre hospitalier associe a une universite. Les donnees ont ete recueillies par un seul investigateur pour tous les episodes d'infection par catheter soupconnes ou documentes (bacteriemie) durant la periode de 24 mois commencant le 1er mai 1994 et se terminant le 31 avril 1996. Le traitement de chaque CRI confirmee a egalement ete consigne. Resultats: Des 135 cas soupconnes de CRI, 74 ont ete confirmes en utilisant les criteres du Centre for Disease Control. Les catheters sous-claviers permanents et temporaires etaient associes au plus haut taux d'infection. La presence de pus au point d'insertion du catheter a ete le plus souvent associee a une CRI confirmee (75%). Des 74 cas de CRI confirmes, l'agent pathogene le plus frequemment isole etait S. epidermidis (47/74, 63,5 %) et S. aureus (23/74, 31 %). Vingt-six p. cent des cas confirmes de CRI presentaient des isolats de S. epidermidis ou de S. aureus resistants a tous les antibiotiques couramment utilises pour eradiquer les microorganismes gram-positifs, comme la cefazoline, la cloxacilline et la clindamycine, mais sont demeures sensibles a la vancomycine. Conclusions: Suite a l'administration d'une close empirique de vancomycine, l'administration de cefazoline devrait etre envisagee pour le reste du traitement clans tous les episodes ou une sensibilite in vitro du micro-organisme a la cefazoline a ete etablie.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".