Infection of AV fistula: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *Often presents with signs of systemic [[sepsis]] ([[fever]], [[hypotension]], leukocytosis) | ||
**Classic signs of pain, erythema, swelling, discharge from infected access are often missing | **Classic signs of pain, erythema, swelling, discharge from infected access are often missing | ||
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[[Category:Renal]] | [[Category:Renal]] | ||
[[Category:Vascular]] | [[Category:Vascular]] | ||
[[Category:ID]] | |||
Latest revision as of 17:11, 16 October 2019
Background
- Dialysis catheter–related bacteremia is common and potentially life-threatening
Clinical Features
- Often presents with signs of systemic sepsis (fever, hypotension, leukocytosis)
- Classic signs of pain, erythema, swelling, discharge from infected access are often missing
Differential Diagnosis
AV Fistula Complications
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
Workup
- Draw peripheral and catheter blood cultures simultaneously
- 4x higher colony count in catheter blood culture suggests catheter is source of bacteremia
Management
- Give vancomycin 1gm IV +/- gentamicin 100mg IV (if gram neg suspected)
- Do not remove dialysis patient's access
- Catheter is only removed if fever persists for 2-3d after antibiotics are started
Disposition
- Admit