Effectiveness of a protocol for the prevention of hemodialysis venous catheter-related infections.

PURPOSE: Infections are a major complication of the use of hemodialysis central venous catheters. In our study we evaluated the efficacy of the hemodialysis central venous catheter protocol management adopted in our center, through a retrospective analysis of all hemodialysis central venous catheters inserted over a period of 6 years. METHODS: Seventy-three tunneled central venous catheters and 75 temporary central venous catheters were inserted in our center from 2003 to 2008 in 148 patients. RESULTS: During the follow-up we observed 30 infective events (16 assessed as bacteremias, 14 subcutaneous tunnel or exit site infections) with a rate of 0.65/1,000 days of central venous catheter implantation. CONCLUSIONS: Our experience confirms, in a 72-month follow-up, the importance of careful central venous catheter management as a crucial feature in reducing the incidence of infective events in patients with central venous catheters in dialytic treatment.

Long-term prognosis of diffuse proliferative glomerulonephritis associated with infection in adults.

BACKGROUND: Infection-associated glomerulonephritis is rare in adults and its long-term prognosis is undefined. METHODS: We retrospectively evaluated the clinical course of 50 adults (30 men, 20 women) with infection-associated glomerulonephritis diagnosed in our department from 1979 to 1999. The mean follow-up was 90+/-78 months. Patients were subdivided into two groups: group 1 included those without underlying disease and group 2 included those with severe underlying disease. RESULTS: At presentation, the median age was 54 years, and 33 patients were hypertensive, 31 had nephritic syndrome, eight had nephrotic syndrome and 11 had non-nephrotic proteinuria. Patients in group 2 were significantly older and had a significantly higher proteinuria than patients of group 1. Of the 21 patients in group 2, nine had liver cirrhosis, four cancer, five diabetes, three bronchiectasis, one thalassaemia intermedia, one polymyositis and one had anti-phospholipid antibodies syndrome. At the last follow-up, five patients had died, 21 patients were in complete remission, ten had partial remission, ten had renal insufficiency and three were on chronic dialysis. Multivariate analysis showed that an underlying disease (P=0.04) and interstitial infiltration at biopsy (P=0.036) were predictors of incomplete recovery. A correlation analysis between the year of diagnosis and the clinical/ histological characteristics at presentation showed that age (P=0.05), atypical infections (P=0.01), underlying disease (P=0.01) and interstitial infiltration at biopsy (P=0.02) increased over time, while the number of patients with complete remission significantly decreased (P=0.001). CONCLUSIONS: Infection-associated glomerulonephritis may progress to chronic renal failure in a consistent number of adult hospitalized patients, particularly in those with an underlying disease and when associated with interstitial infiltration at biopsy.