2020 Volume 53 Issue 11 Pages 539-546
Patients on maintenance hemodialysis are susceptible to infectious disease, which is the second most common cause of death in dialysis patients. Therefore, it is important to understand the etiology of severe infections that require inpatient treatment in order to develop countermeasures against such infections. We investigated the cases of 1174 hospitalized patients who underwent blood purification therapy at our hospital within the past 5 years. Among these patients, 137 were hospitalized due to infections. The etiologies of the infections and the backgrounds of the patients were summarized and described in this study. Skin and soft tissue infections (SSTIs) were the most common infections (n=67, 48.9%). SSTIs were also the most common infections in patients with sepsis (n=35) and patients that died due to their infections (n=16). Compared with those with other infections, the patients with SSTIs were significantly younger (66.3±10.2 years vs. 72.0±9.8 years, respectively; p=0.0019), had been on dialysis longer (128.1±115.0 months vs. 87.0±96.9 months, respectively; p=0.0102), and required longer periods of hospitalization (83.1±90.6 days vs. 35.8±32.7 days; respectively, p<0.0001). The frequency of diabetic nephropathy was significantly higher among the patients with SSTIs (79% vs. 45%, respectively; p=0.0007), as was the frequency of re-hospitalization due to recurrence of the infection (54% vs. 19%, respectively, p=0.0006). Bacterial infections in chronic lower limb wounds, which account for the majority of SSTIs, require antibacterial treatment and revascularization, including endovascular treatment and vascular bypass surgery, or surgical resection of the infected wound. In addition to these treatments, it is critically important to detect wounds and infections at an early stage and to employ a multifaceted approach to patient care.
