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Fungal infections of dialysis fistulae

I M Onorato, J L Axelrod, J A Lorch

    Annals of Internal Medicine
    |July 1, 1979
    PubMed

    Insights

    Fungal infections of dialysis grafts are a newly identified complication in end-stage renal disease patients. Prompt graft removal and antifungal treatment are recommended if fungus is detected.

    Area of Science:

    • Nephrology
    • Infectious Diseases
    • Mycology

    Background:

    • Bacterial infections of dialysis access fistulae are common in patients with end-stage renal disease.
    • Fungal infections of these vascular prostheses have not been previously reported.

    Observation:

    • Two patients with end-stage renal disease experienced recurrent infections and thromboses of their dialysis grafts.
    • Cultures from the grafts of both patients yielded Staphylococcus aureus and Cephalosporium species.

    Findings:

    • This case series identifies fungal infection, specifically by Cephalosporium species, as a novel cause of dialysis graft failure.
    • The presence of fungus in a clotted graft suggests a distinct pathological entity requiring specific management.

    Implications:

    • Management of clotted dialysis grafts in end-stage renal disease patients should consider fungal etiologies.
    • Recommended treatment for fungal graft infection includes extirpation of the graft and administration of amphotericin B.
    • Further research into the mycology of Cephalosporium and in-vitro sensitivity is warranted.

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