Program Book - Keck School of Medicine of USC - University of ...

Vascular AccessInfection: Medical,Surgical ManagementRobert J. Hye, M.D.SCPMG, San DiegoDialysis Access Infection• Major Problem in Dialysis Population• Second leading cause of death aftercardiovascular disease• Leading cause of hospitalization• Often results in loss of access sites• May require temporary catheter use• Major driver of cost associated with vascularaccess• UremiaPre-disposing Factors forInfection in HemodialysisPatients• Directly impairs chemotaxis, phagocytosis and adherence ofneutrophils• Secondary metabolic changes also affect neutrophil function• Increase neutrophil apoptosis• Cell-mediated immunity depressed• Diabetes• Loss of natural barriers due to invasive procedures• Surgery, cannulation, IR procedures• Changes in bacterial flora• Markedly higher rates of S. aureus colonization99