Single-Center Review of Infections Associated with 1,574 Consecutive Vascular Access Procedures

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Abstract
The objective of this study was to establish accurate infection rates and causes for vascular access procedures and provide information helpful in identifying means of reducing infections. Between January 1, 1996, and December 31, 2001 (60 months), a single surgeon (AFS) performed 1,574 consecutive vascular access procedures (850 patients) in 1 academic medical center. Recently, a retrospective review of these records revealed that 87 patients (10.2% of this population) underwent removal of access grafts or fistula for infection. In these 87 patients, 131 grafts and 1 fistula were removed. Thus, 8.4% (132/1,574) of the total surgeries were for infection. This review included evaluation of repeat infection, causative organism, and HIV status. Cause of infection fell into 5 major categories. Of the 87 patients, 26 had multiple graft infections. Diabetes and hypertension lead to increased end-stage renal disease, requiring more vascular access procedures. Following thrombosis, infection is the most common complication in vascular access. Therefore, mechanisms to reduce infection would be well received. These data suggest that operative infection accounted for only 6% of infective procedures, and when the entire population is considered, the operative infection rate was 0.51%. However, infections secondary to routine dialysis make up more than 50% of this infective operative population. The authors note that 17% of the infective operations were in previously infected grafts that were not initially completely removed and 23% developed in nonfunctional grafts. Multiple graft infections played a significant role in the investigation and warrant further evaluation.