Infection of AV fistula

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

See Also

• Dialysis complications