Objective: To determine the epidemiological risk factors associated with permanent access-site (PAS) infection in a population of chronic hemodialysis patients.
Design: Retrospective cohort analysis.
Setting: Hemodialysis unit of a 400-bed Department of Veterans' Affairs hospital.
Results: A cohort of 94 males (1,316 patient months) was studied. Fifty-one PAS infections in 31 patients were observed. Six patients had two PAS infections, four patients had three infections, and two patients had four infections. Twenty-nine of the 31 patients with PAS infections were bacteremic at least once. Univariate analysis identified seven factors significantly associated with PAS infection in this population: location of PAS other than forearm, type of vascular access (polytetrafluoroethylene [PTFE] versus endogenous arteriovenous [AV] fistula), limited ambulatory status, residence in a nursing home, bacterial infection at a distant site, number of access-site revisions, and number of hospitalizations. In a logistic regression analysis, only graft type and number of PTFE graft revisions were associated independently with PAS infection. The odds ratio for PAS infection in PTFE grafts compared to endogenous AV fistula was 7.8; the odds ratio for PAS infection with each PTFE graft revision was 1.5.
Conclusions: PAS infections were associated independently with the type of graft and the number of PTFE graft surgical revisions.