Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis

• Published in: Annals of internal medicine Vol. 127; no. 4; p. 275
• Main Authors: Marr, K A, Sexton, D J, Conlon, P J, Corey, G R, Schwab, S J, Kirkland, K B
• Format: Journal Article
• Language: English
• Published: United States 15.08.1997
• Subjects: Adult; Aged; Aged, 80 and over; Arteriovenous Shunt, Surgical - adverse effects; Bacteremia - etiology; Bacteremia - microbiology; Bacteremia - therapy; Catheters, Indwelling - adverse effects; Female; Gram-Negative Bacteria - isolation & purification; Gram-Positive Bacteria - isolation & purification; Humans; Incidence; Male; Middle Aged; Outpatients; Prospective Studies; Recurrence; Renal Dialysis; Risk; Treatment Outcome
• ISSN: 0003-4819
• DOI: 10.7326/0003-4819-127-4-199708150-00003

Dual-lumen cuffed catheters are used for vascular access in patients undergoing hemodialysis. The incidence and appropriate management of catheter-related bacteremia are unknown. To determine the incidence and outcome of catheter-related bacteremia and to assess the efficacy of catheter salvage. Prospective, observational study. University hospital inpatient service and four affiliated outpatient dialysis units. 102 patients with end-stage renal disease who underwent hemodialysis with dual-lumen cuffed catheters between 1 April 1995 and 1 January 1996. Number of days that the catheter remained in situ, treatment (catheter removal or attempted salvage with antibiotic therapy), and outcome of bacteremia. Microbiological cultures were done to identify catheter-related bacteremia. 102 patients had a total of 16,081 catheter-days. Forty-one patients (40%) developed 62 episodes of bacteremia (3.9 episodes per 1000 catheter-days [95% CI, 3.0 to 4.9 episodes per 1000 catheter-days]). Twenty-four catheters (39%) were removed immediately, and 38 (61%) were left in place during treatment. Only 12 (32%) of the 38 catheters were salvaged successfully. Salvage was less likely to succeed in patients with gram-positive bacteremia than in patients with gram-negative bacteremia, but this difference was not statistically significant (P = 0.14). Nine of the 41 patients (22%) who developed bacteremia had the following complications: osteomyelitis (6 patients), septic arthritis (1 patient), infective endocarditis (4 patients), and death (2 patients). All complications followed an episode of gram-positive bacteremia, and none was associated with attempted catheter salvage. Bacteremia frequently occurs in patients undergoing hemodialysis with dual-lumen catheters. Antibiotic therapy without catheter removal is unlikely to eradicate catheter-related bacteremia in these patients, but attempted salvage may not increase the risk for complications.