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J Infect. 2014 Feb;68(2):105-15. doi: 10.1016/j.jinf.2013.10.003. Epub 2013 Oct 15.

Description and predictive factors of infection in patients with chronic kidney disease admitted to the critical care unit.

Author information

1
Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France.
2
Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, France.
3
Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, 4, rue de la Chine, 75020 Paris, France. Electronic address: muriel.fartoukh@tnn.aphp.fr.

Abstract

OBJECTIVES:

To describe the spectrum of infection and multidrug-resistant bacterial colonization, and to identify early predictors of infection in patients with chronic kidney disease (CKD) admitted to the critical care unit (CCU).

METHODS:

A 7-month observational prospective single-centre study in a French university hospital.

RESULTS:

791 patients were admitted to the CCU, 135 of whom (17%) had severe CKD. Among these, 41 (30%) were infected on admission. Infection was microbiologically documented in 32 patients (78%), of which 7 (22%) were related to Pseudomonas aeruginosa. There was no infection related to extended-spectrum β-lactamase-producing enterobacteriaceae despite a 12% carriage rate on admission. A temperature ≥37.6 °C and a leukocyte count >12.000/mm³ were specific but poorly sensitive of infection (91% and 80%, and 45% and 39%, respectively). Using the threshold of 0.85 ng/ml, procalcitonin was a strong independent predictor of infection on admission (OR 12.8, 95% CI 4.4-37.3). Age (≥60 years) and the cause of CKD were two other predictors.

CONCLUSIONS:

Infection accounts for one-third of CCU admissions in CKD patients, with a high prevalence of P. aeruginosa. The usual diagnostic criteria are inaccurate for diagnosing infection in this population. A procalcitonin ≥0.85 ng/ml might be helpful for early identifying CKD patients with infection.

KEYWORDS:

Chronic kidney disease; Epidemiology; Fever; Haemodialysis; Infection; Intensive care unit; Multidrug-resistant bacterial colonization; Procalcitonin

PMID:
24140065
DOI:
10.1016/j.jinf.2013.10.003
[Indexed for MEDLINE]

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