'Header sepsis' syndrome: Waterborne xanthomonas-induced fevers

B. W. Roberts, N. Alvarado, W. Garcia, Y. Solis, O. Lopez, C. E. Dukes

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


This case series involved the appearance of unexplained episodes of fever and chills in 21 hemodialysis patients over a two-month period that usually occurred during or just after dialysis. There were no deaths, but there was one cardiac arrest. Seventeen of the 21 episodes were associated with a normal WBC and 12 occurred during treatment. There was no statistically increased number of cases in diabetics. Blood cultures in 12 patients grew Xanthomonas organisms (maltophilia and cepacia) sensitive to ciprofloxacin and trimethoprim-sulfa, while nine of the patients had negative cultures. Standard culture and sensitivity reports were presented an average of 84 hours after the cultures were taken. This may have been due to these organisms being slow growers. It was found that cases occurred only in patients whose dialyzers had removable 'headers'. On advice from CDC and Renal Systems (Minneapolis, MN), the header and 'O-Ring' of each reused dialyzer were dipped in a 1% Renalin sterilizing solution during reuse (and stored without rinsing). This led to cessation of the episodes, and there have been no further unexplained fevers in the unit since April 1991.

Original languageEnglish (US)
Pages (from-to)464-467+470
JournalDialysis and Transplantation
Issue number8
StatePublished - Jan 1 1994

ASJC Scopus subject areas

  • Nephrology
  • Transplantation


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