Pyrogenic reactions associated with the reuse of disposable hollow-fiber hemodialyzers
S. M. Gordon, M. Tipple, L. A. Bland and W. R. Jarvis
Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333.
We investigated 18 pyrogenic reactions (PRs) that occurred between July 1
and 13, 1987, in 16 patients receiving long-term hemodialysis at one
dialysis center in Illinois. We defined a case of PR as the onset of chills
or fever (oral temperature, greater than or equal to 37.8 degrees C) in a
patient who was afebrile and had no signs or symptoms of infection before a
dialysis treatment. Pyrogenic reactions to dialysis sessions during the
epidemic period (July 1 through 14) were associated with the use of a
reused dialyzer (risk ratio, 6.2; 95% confidence interval, 0.8 to 45). The
water used to rinse the dialyzers after use and to dilute the germicide for
disinfecting the dialyzers contained high concentrations of endotoxins
(greater than 6 ng/mL) and bacteria (greater than 10(4) colony forming
units/mL). After reuse of dialyzers was discontinued at the center, the PR
rate fell to pre-epidemic levels. We concluded that PRs were associated
with reuse of dialyzers, probably contaminated with endotoxins. Active
surveillance for PRs among patients undergoing long-term hemodialysis
should be routine at all dialysis centers; an increase in PRs should prompt
timely review of water treatment and dialyzer reprocessing systems.
