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

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• 作者：Damien Contou ; G茅raldine d'Ythurbide ; Jonathan Messika ; Christophe Ridel ; Antoine Parrot ; Michel Djibr茅 ; Alex ; re Hertig ; Eric Rondeau ; Muriel Fartoukh
• 关键词：Chronic kidney disease ; Haemodialysis ; Intensive care unit ; Infection ; Fever ; Procalcitonin ; Multidrug-resistant bacterial colonization ; Epidemiology
• 刊名：Journal of Infection
• 出版年：February, 2014
• 年：2014
• 卷：68
• 期：2
• 页码：105-115
• 全文大小：628 K

文摘

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Summary

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 尾-lactamase-producing enterobacteriaceae despite a 12% carriage rate on admission. A temperature 鈮?7.6聽掳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聽ng/ml, procalcitonin was a strong independent predictor of infection on admission (OR 12.8, 95% CI 4.4-37.3). Age (鈮?0 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 鈮?.85聽ng/ml might be helpful for early identifying CKD patients with infection.