1088
D’AGATA ET AL
4. Miller T, Ormrod D, Collins J: Host defense and
infection in dialysis patients, in Nissenson AR, Fine RN,
Gentiel DE (eds): Clinical Dialysis. East Norwalk, CT,
Appleton & Lange, 1990, pp 559-578
5. Goldblum SE, Reed WP: Host defenses and immuno-
logic alterations associated with chronic hemodialysis. Ann
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dialysis patients who developed a UTI under-
went prior urinary catheterization, the major risk
factor for UTI.14 Thus, to decrease the rate of
nosocomial UTIs and ultimately improve patient
outcome, urinary catheterization in this popula-
tion should be minimized.
6. VanHolder R, Ringoir S: Polymorphonuclear cell func-
tion and infection in dialysis. Kidney Int 38:S91-S95, 1992
7. Emori TG, Ganynes RP: An overview of nosocomial
infections, including the role of the microbiology laboratory.
Clin Microbiol Rev 6:428-442, 1993
8. Charlson M, Pompei P, Ales K, MacKenzie CR: A new
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nal studies: Development and validation. J Chronic Dis
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9. National Nosocomial Infections Surveillance System:
National Nosocomial Infections Surveillance System Manual.
Atlanta, GA, Centers for Disease Control and Prevention,
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10. Murray PR, Baron EJ, Pfaller MA, Tenover FC,
Yolken RH: Manual of Clinical Microbiology (ed 6). Wash-
ington, DC, American Society for Microbiology Press, 1995,
pp 1327-1343
11. Tokars JI, Miller ER, Alter MJ, Arduino MJ: National
Surveillance of Dialysis-Associated Disease in the United
States, 1996. Atlanta, GA, Public Health Service, Depart-
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12. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel
RP: Hospital-acquired candidemia. The attributable mortal-
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Effective surveillance efforts for nosocomial
infections require stratification by severity of
underlying illness and exposure to invasive de-
vices. By risk-adjusting rates of nosocomial in-
fections, valid interhospital and intrahospital com-
parisons can be performed.15-17 The optimal
method for stratification for severity of underly-
ing illness, especially in patients outside of the
ICU, is not clear. In this study, the Charlson
index was used as a measure of comorbidity.
This simple scoring system generates a compos-
ite value for age and preexisting medical condi-
tions and has been validated in the population of
end-stage renal disease.18 Among chronic hemo-
dialysis patients, those with a high score were at
significantly greater risk for acquiring a nosoco-
mial infection. Thus, future surveillance efforts
of nosocomial infections among the dialysis popu-
lation should consider using the Charlson score,
in addition to device exposure, to obtain risk-
adjusted rates of nosocomial infections.
This study underscores the importance of noso-
comial infections in the chronic hemodialysis
population. The distinctive distribution of patho-
gens suggests that nosocomial infections in this
population may be associated with greater rates
of morbidity and mortality compared with hospi-
talized patients not requiring chronic hemodialy-
sis. Because more than one third of nosocomial
infections are preventable, intense surveillance
efforts and prevention measures should focus on
this high-risk and rapidly growing population.1,19
13. Hughes WT: Systemic candidiasis: A study of 109
fatal cases. Pediatr Infect Dis 1:11-18, 1982
14. Burke JP, Riley K: Nosocomial urinary tract infec-
tions, in Mayhall G (ed): Hospital Epidemiology and Infec-
tion Control. Baltimore, MD, Williams & Wilkins, 1996, pp
139-153
15. National Nosocomial Infections Surveillance Sys-
tem: National Nosocomial Infections Surveillance System
(NNIS) report: Data summary from October 1986-April
1997. Am J Infect Control 25:477-487, 1997
16. Britt MR, Schleupner CJ, Matsumiya S: Severity of
underlying disease as a predictor of nosocomial infection.
Utility in the control of nosocomial infections. JAMA 239:
1047-1051, 1978
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