TY - JOUR
T1 - Chills During Hemodialysis
T2 - Prediction and Prevalence of Bacterial Infections – A Retrospective Cohort Study
AU - Shepshelovich, Daniel
AU - Yelin, Dana
AU - Bach, Lior Or
AU - Halevy, Noy
AU - Ziv, Yonatan
AU - Green, Hefziba
AU - Rozen-Zvi, Benaya
AU - Ben-Zvi, Haim
AU - Bishara, Jihad
AU - Gafter-Gvili, Anat
AU - Yahav, Dafna
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Introduction Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established, and empirical broad-spectrum antibiotics are usually the rule. Methods We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection. Results Overall, 269 hemodialysis patients with a first episode of chills were included. Ninety patients (33.5%) had bacteremia and 162 (60.2%) had an infection. Risk factors for bacteremia in multivariate analysis included fever (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.1-2.3; P = .009) and vascular catheter as dialysis access (OR 6.2; 95% CI, 3.2-12.0, P <.001). Leukocytosis was an additional risk factor in multivariate analysis for any type of infection (OR 1.265; 95% CI, 1.113-1.438; P <.001). Using a prediction model to evaluate patients without obvious source of infection, we found that patients with fistula or graft as their access, without fever, abnormal leukocytes, or hypoalbuminemia, had a low rate (1/17, 6%) of bacteremia. Conclusions Hemodialysis patients presenting with chills during dialysis, with or without fever, have high rates (∼60%) of infection. Patients with no obvious source of infection, with fistula or graft as access, presenting without fever, leukocytosis, or hypoalbuminemia have low risk for bacteremia and may be investigated without prompt antibiotic treatment. All other patients should receive antibiotic coverage immediately following a chills episode.
AB - Introduction Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established, and empirical broad-spectrum antibiotics are usually the rule. Methods We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection. Results Overall, 269 hemodialysis patients with a first episode of chills were included. Ninety patients (33.5%) had bacteremia and 162 (60.2%) had an infection. Risk factors for bacteremia in multivariate analysis included fever (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.1-2.3; P = .009) and vascular catheter as dialysis access (OR 6.2; 95% CI, 3.2-12.0, P <.001). Leukocytosis was an additional risk factor in multivariate analysis for any type of infection (OR 1.265; 95% CI, 1.113-1.438; P <.001). Using a prediction model to evaluate patients without obvious source of infection, we found that patients with fistula or graft as their access, without fever, abnormal leukocytes, or hypoalbuminemia, had a low rate (1/17, 6%) of bacteremia. Conclusions Hemodialysis patients presenting with chills during dialysis, with or without fever, have high rates (∼60%) of infection. Patients with no obvious source of infection, with fistula or graft as access, presenting without fever, leukocytosis, or hypoalbuminemia have low risk for bacteremia and may be investigated without prompt antibiotic treatment. All other patients should receive antibiotic coverage immediately following a chills episode.
KW - Bacteremia
KW - Chills
KW - Dialysis
KW - Infections
UR - http://www.scopus.com/inward/record.url?scp=85009887748&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2016.11.022
DO - 10.1016/j.amjmed.2016.11.022
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C2 - 27993572
AN - SCOPUS:85009887748
SN - 0002-9343
VL - 130
SP - 477
EP - 481
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 4
ER -