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Tubes called catheters that are used to draw and return blood to the body during dialysis appear to cause the majority of bloodstream infections in people receiving dialysis for kidney problems, a new study finds.
Three-quarters of bloodstream infections in dialysis patients were related to accessing their blood, the 2014 US Centers for Disease Control and Prevention data showed.
The information came from more than 6 000 outpatient dialysis centres in 2014. There were nearly 30 000 bloodstream infections reported, the study found.
The analysis also found that 63% of all bloodstream infections and 70% of access-related bloodstream infections occurred in patients with a central venous catheter – also called a central line. Other dialysis complication rates were also highest among patients using central venous catheters, the findings showed.
Staphylococcus aureus was the most common bacterial cause of bloodstream infections (31%). 40% of the S. aureus samples were resistant to the antibiotic methicillin (“MRSA”), the investigators found.
Dialysis not available for everyone
Dialysis is necessary in the case of end stage kidney failure when your own kidneys can no longer filter your blood, i.e. when you have lost more than around 85% of your kidney function.
Healthy kidneys filter out excess fluid and wastes. The kidneys also produce hormones that keep your bones strong, blood chemically balanced and stimulate your bone marrow to make red blood cells. These cells carry oxygen in your blood to your organs.
Since 2012 dialysis patients in South Africa are able to undergo dialysis at night. National Renal Care (NRC), South Africa’s largest private dialysis therapy provider and a joint venture between Netcare and Adcock Ingram Critical Care, has introduced a groundbreaking new nocturnal or overnight, dialysis programme.
It is estimated that in South Africa only about a third of those living with kidney conditions are receiving life-saving dialysis.
Other options available
Dialysis patients have an increased risk for infection due to the repeated need to access their blood, the study authors explained.
“Our findings emphasise the need for haemodialysis facilities to improve infection prevention and vascular access care practices,” study author Dr Duc Bui Nguyen, from the CDC, said in a news release from the American Society of Nephrology.
The study authors said there are other options available for dialysis patients, such as an arteriovenous fistula. This is created by connecting a patient’s own vein and artery to form a long-lasting site through which blood can be removed and returned.
Another option is an arteriovenous graft, which is a plastic conduit between an artery and a vein, the researchers said.
Findings from the study were published in the Clinical Journal of the American Society of Nephrology.
In an editorial accompanying the study, Dr Dana Miskulin of Tufts University School of Medicine and Dr Ambreen Gul of Dialysis Clinic, Inc., explained that part of the problem may be that dialysis units have been placed on an “honour system” when it comes to reporting adverse events.
The editorialists “make a plea to the dialysis community to ‘clean up’ the data, so that the quality incentive programme is fairer for all, and to enable the full potential of these data… to be realised.”
True penicillin allergy is rare with the estimated frequency of anaphylaxis at only 1–5 per 10 000 cases of penicillin therapy. Hypersensitivity reactions are in fact the major problem in the use of penicillin.
Some children may be having a true allergic reaction, but it could be caused by something else instead of the inexpensive, first-line antibiotic penicillin, new research indicates.
The findings – which echo similar research earlier this year in adults – mean many patients are instead prescribed more expensive broad-spectrum antibiotics, experts said. These alternatives can come with greater side effects and contribute to a rise in antibiotic-resistant infections.
According to a previous report in the Current Allergy & Clinical Immunology, many children with the label of penicillin allergy can safely take the drug without fear of an allergic reaction.
The study was published online in the journal Pediatrics.
Unnecessary use of less effective antibiotics
“It’s important to question this because it leads to a substantial increase in costs, for both families and the health care system, when we have to switch to a more broad-spectrum antibiotic,” said study author Dr David Vyles. He’s an attending paediatric emergency medicine physician at Medical College of Wisconsin in Milwaukee.
“We think many cases aren’t a true allergic reaction,” he added. “It substantially limits the type of antibiotics that can be prescribed.”
More than 266 million courses of antibiotics were dispensed to outpatients in US pharmacies in 2014, according to the US Centers for Disease Control and Prevention. This equates to more than five prescriptions written each year for every six people.
Statistics reflecting the number of antibiotic courses dispensed in South Africa are not available.
Vyles and his team analysed questionnaires from nearly 600 parents of children aged four to 18 that described their child’s reported allergy symptoms. The families came to an urban paediatric emergency department over a span of 19 months.
Not a new concept
Health24 reported that viral infections could also be misdiagnosed and in some cases, patients simply don’t remember their experience correctly.
Just over 300 of the children had previously experienced low-risk symptoms for penicillin allergy, including rash, vomiting or diarrhoea, according to parents.
Of those, 100 children were tested for penicillin allergy using a standard, three-part testing process. This includes a skin test; an injection with a tiny amount of penicillin; and an “oral challenge” in which the child swallows a dose of penicillin under close medical supervision.
All 100 children tested were found not to be allergic to penicillin and had the designation removed from their medical record, the researchers said.
“During my paediatric residency and fellowship, we constantly saw families reporting a penicillin allergy and were questioning the validity” of the claim, Vyles said. Two of his three young children have also been wrongly identified as allergic to the drug, he noted.
Why the confusion?
Vyles and another expert said many parents notice that their children have a rash around the same time they’re prescribed penicillin. But the rash is likely due to an infection, not the drug.
“Many infections are associated with a rash, and if a child is given an antibiotic for this illness or some other reason, the rash can be falsely attributed to a penicillin allergy,” explained Dr Stephen Eppes. He’s vice chair of paediatrics and director of paediatric infectious diseases at Christiana Care Health System in Wilmington, Delaware.
Eppes, who wasn’t involved in the new research, said up to 10% of people are either told or believe they’re allergic to penicillin. But when they’re tested for the allergy, more than 90% of them are not actually allergic to the drug.
Misdiagnosis of allergy
“Either the diagnosis of penicillin allergy was inaccurate to start with, or they had a hypersensitivity to it that went away over time,” he said. “I think the former is more common – meaning people think they had a reaction that’s not truly an allergy.”
Another misconception is that penicillin allergy is hereditary, Eppes noted, so some parents who are allergic to the drug assume their children are as well.
And since the three-pronged standard testing for penicillin allergy takes about three hours to complete, many are unwilling to go through with it, the doctors said.
In a continued study based on the new findings, Vyles said he plans to proceed directly to the “oral challenge” in children identified as low risk for penicillin allergy while still being treated in the hospital emergency department.
The information on Health24 is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional. See additional information.
There are many injuries that can occur while playing sport – or during everyday activities for that matter.
Most of these injuries, whether mild or severe, rare or frequent, sound familiar to our ears. A few, however, have really unusual or exotic names.
Here are 10 sports injuries with odd names:
Joanne and Mark Wishick are thought to be the first in the UK to each give kidneys to their children.