Hemodialysis-associated endovascular device infection
| Autor: | Robert W. Nappo, Jennifer L. Paugh-Miller, Edward A. Ross |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Transplantation
medicine.medical_specialty Teaching Points business.industry Osteomyelitis medicine.medical_treatment Stent medicine.disease Dialysis patients Occult Surgery Educational Papers Animal model Nephrology Bacteremia endocarditis medicine Endocarditis stent Hemodialysis bacteremia business |
| Zdroj: | Clinical Kidney Journal |
| ISSN: | 2048-8513 2048-8505 |
| DOI: | 10.1093/ckj/sft166 |
| Popis: | Bacteremia is a major concern in hemodialysis patients being evaluated for fever, and identifying a source of ongoing infection is often challenging. In the absence of an obvious catheter-related nidus, clinicians typically consider a wide range of entities including endocarditis, osteomyelitis, joint infections and epidural abscesses. Despite advanced CT, magnetic or radionuclide imaging techniques, however, the site of continuing or relapsing infection can remain occult. We believe that endovascular stents are an under-appreciated potential location for such infections. The use of these devices has become increasingly common and is of particular concern when deployed for access-associated venous stenoses in dialysis patients. With the widespread use of endovascular devices, and especially in circumstances when care is rendered at multiple facilities, the patients and their medical providers may be unaware that those devices are present. There is much human and animal model literature describing the use of arterial and venous stents made from bare metal or combined with polymeric materials [1]. Although they are subject to infection upon implantation, it appears that the risk decreases with the endothelialization that historically was thought to occur over approximately 4 weeks. The speed and ultimate coverage area of cell growth is, however, controversial [2]. There is evidence that stents can become infected more than a month post-insertion, perhaps when associated with incomplete endothelial growth, thrombi or local trauma (e.g. needle cannulation) [3]. We present here a patient with persistent bacteremia due to an infected vena cava stent, complicated by the presence of a vegetation. This case highlights the importance of detecting these devices when evaluating febrile hemodialysis patients and the challenges in determining the optimal surgical or medical plan of care. |
| Databáze: | OpenAIRE |
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