To the Editor.—
A major complication of hemodialysis is infection of the access site. Organisms implicated in accesssite infections have included Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Streptococcus faecalis, Streptococcus viridans, a variety of gram-negative bacilli, Listeria monocytogenes,1 and Legionella pneumophila.2 We report a case of a hemodialysis patient with an arteriovenous-graft infection caused by Candida albicans and emphasize the importance of Gram's stain in early evaluation of access-site infections.
Report of a Case.—
A 67-year-old man was healthy until 1984, when bilateral ureteral obstruction with renal failure developed; maintenance hemodialysis was started. In 1986, an arteriovenous shunt using a Gortex prosthesis was created in his left arm. Two weeks after surgery the patient became confused and serous yellow material was found oozing from the surgical wound. He remained afebrile, but his white blood cell count was 17·1×109/L (17 100/mm3), with 0·65 (65%) neutrophils (10%
Berman DS, Diamond GR, Rubin DS, El-Sadr W, Simberkoff MS. Candida albicans Infection of an Arteriovenous Graft Used for Hemodialysis. JAMA. 1987;258(5):614. doi:10.1001/jama.1987.03400050056026