Vascular access infection: survival or mortality.

METHODS

We conducted an analysis on 11 cases of death after AVG infection that occurred between 1996 and 2013, and compared their information with those of 23 cases of generalized infection due to arteriovenous graft (AVG) infection during the same period who survived.

RESULTS

The cause of death was sepsis in all 11 patients. The initial C-reactive protein (CRP) was 10.2-39.8 (28 in average) and the duration from onset of fever to vascular access (VA) hemostasis/removal procedure was 6-9 days (6.4 days in average) in the 11 cases of death. Blood culture revealed a high frequency of methicillin-resistant staphylococcus aureus (MRSA) in 7 of the 11 cases of death. In contrast, in 23 survivors with VA infection and generalized infection, the CRP at the initial visit was 3.2-15.8 (5.6 in average) and the duration from onset of the fever to VA hemostasis/removal procedure was 0-5 days (2.6 days in average), and blood culture revealed a high frequency of methicillin-sensitive staphylococcus aureus (MSSA). Among the cases of death, although VA infection in the upper extremity itself resolved after removing the artificial vessel, they died without an improvement of sepsis. The reason why the sepsis did not resolve is that infectious foci were secondarily formed in other areas than the upper extremity because the start of treatment for VA infection was delayed.

CONCLUSIONS

Treatment for VA infection should be started as early as possible after onset to avoid the formation of secondary infectious foci in other areas.