| [ Summary ] |
Infectious diseases remain the leading cause of death in addition to heart failure in Japanese patients undergoing dialysis. Overall, the risk of sepsis remains high in these patients and contributes to a high mortality rate. We studied a group of 91 patients (41 women) who had been clinically diagnosed with sepsis. Twenty-one bacterial species and 143 bacterial strains were identified in this group. Gram-positive cocci accounted for 75.5 % of all, and Staphylococci accounted for approximately 84.3 % of the gram-positive cocci, whereas MRSA and methicillin-resistant coagulase-negative Staphylococci accounted for 70 % of the entire Staphylococcal population. Notably, 56 patients showed the presence of an indwelling catheter. Concomitant infections included 21 cases of catheter infection, 12 of urinary-tract infection, 9 of respiratory infection and 6 of dermal gangrene and bedsores. Overall, 57 patients died all over the progress, and approximately 50 % of these patients showed the presence of resistant Staphylococci. Multivariate analysis showed that the levels of C-reactive protein (odds ratio [OR] 1.070,95 % confidence interval [CI] 1.017-1.126) and serum albumin (OR 0.193, CI 0.071-0.524) were associated with an increased risk of mortality. We emphasize the role of 3 primary strategies in prevention of sepsis in patients undergoing dialysis: 1) Combating an infection by surgical removal of an infected part. 2) Improvement in the physical condition of patients. 3) The prompt administration of effective and appropriate chemotherapy. Additionally, reducing the use of catheters would serve as an effective evidence-based strategy to reduce a patient's vulnerability to infection. |