Can Patients on AVF for Hemodialysis Develop CRBSI?
No, patients receiving hemodialysis through a mature arteriovenous fistula (AVF) cannot develop catheter-related bloodstream infection (CRBSI) because CRBSI is by definition an infection specifically caused by an intravascular catheter, which an AVF is not. 1, 2
Understanding the Terminology
The term "catheter-related bloodstream infection" (CRBSI) applies exclusively to infections originating from central venous catheters (CVCs), not arteriovenous fistulas or grafts. 1 This is a critical distinction:
- CRBSI requires the presence of an intravascular catheter and is defined as isolation of the same organism from quantitative cultures of both the catheter and peripheral blood in a patient with clinical features of infection without another apparent source 1, 3
- AVF-related infections are an entirely different entity, presenting as local access site infections or bacteremia, but are not classified as CRBSI 2, 4
AVF Infection Risk Profile
While AVFs cannot cause CRBSI, they do carry the lowest infection risk of all hemodialysis access types:
- AVF infection rates: 1-4% over the entire lifetime of use, representing the lowest infection risk among all vascular access options 2
- Bacteremia rates: 0.2 per 1,000 dialysis procedures with AVF 1
- Relative risk: 7-fold lower bacteremia risk compared to catheters 1, 5
Infection Risk Hierarchy in Hemodialysis Access
Understanding the complete spectrum helps contextualize why the terminology matters:
- AVF (lowest risk): 0-11 bacteremia episodes per 100 patient-years 1
- AVG (intermediate risk): 11-20% infection rate during expected usage period 2
- Tunneled CVC: 1.6 infections per 1,000 catheter-days, with 50% removal due to infection at 1 year 2, 5
- Non-tunneled CVC (highest risk): 2.7 infections per 1,000 catheter-days 5
Clinical Implications
When evaluating a febrile hemodialysis patient with an AVF, consider AVF-related bacteremia as a potential diagnosis, but do not use the term CRBSI. 4 The diagnostic approach differs:
- For catheter patients: Obtain paired blood cultures (one from catheter, one peripheral) to diagnose CRBSI 1, 3
- For AVF patients: Obtain peripheral blood cultures and examine the access site for local infection signs (erythema, purulence, warmth) 1, 4
Common Pitfall to Avoid
Do not conflate all hemodialysis access-related infections with CRBSI. 4 This terminology error can lead to:
- Inappropriate application of catheter-specific management guidelines to AVF infections 1
- Misclassification in infection surveillance databases 1
- Confusion regarding infection prevention strategies, as AVF and catheter infections have fundamentally different pathophysiology 2, 6
The 70-80% of patients who initiate dialysis with catheters are at risk for CRBSI, but once transitioned to a mature AVF, they are no longer susceptible to this catheter-specific complication. 6, 4