Bacteremia Associated with Tunneled Hemodialysis Catheters

Abstract

Background and objectives: Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood of treatment success.Design, setting, participants, & measurements: In a prospective cohort study, all cases of catheter-associated bacteremia that occurred in a large dialysis center were identified during a 12-mo period. Catheter salvage was attempted according to a standard protocol in all cases in which a favorable early response to antibiotic therapy was seen, and patients were followed for at least 6 mo. Bacteremias, catheter changes, and all major clinical events were recorded.Results: During a period covering 252,986 catheter days, 208 episodes were identified involving 133 patients, 74% of which were selected for attempted salvage. Salvage was successful in 66.1% of incident bacteremias with a very low complication risk (0.9%). Some bacteremias, however, recurred as late as 6 mo after the initial infection; salvage was less likely to be successful in treating recurrences.Conclusions: Appropriately used catheter salvage can be successful in approximately two thirds of cases; however, recurrences continue to occur up to 6 mo later and are unlikely to be cured without catheter replacement.

Systematic Review and Meta-Analysis on Management of Hemodialysis Catheter-Related Bacteremia

“…Six articles also noted results of patients that had catheter removal/replacement. These patients' clinical pictures were similar to the patients' clinical pictures who underwent guidewire exchange in one study, 32 but in other studies, it was clearly reserved for those patients with sepsis or severe disease 10,16,31 or was unclear. 3,15 Individual study characteristics are described in Table 1.…”

“…Several studies report success rates between 66% and 89% when CRB was treated with removal and subsequent replacement of the HD catheter. 3,15,16,32 The two strategies (guidewire exchange and removal/replacement) do not show a difference in outcome in two studies, 3,32 whereas removal/replacement showed a higher success rate in one study, 15 although they are all nonrandomized observational studies. The results of this meta-analysis suggest that the use of guidewire exchange for S. aureus or GNR bacteremia may be a reasonable up-front treatment option.…”

Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP)

“…An alternative option is to leave the catheter in place and to attempt catheter salvage instilling an antibiotic lock (see below, 'Antibiotic locks') in addition to systemic antibiotic therapy [72,73] (30)(60). In a recent study, catheter salvage after incident bacteraemia achieved a cure, defined as no recurrence or complication, in 66.1% of cases [74]. Recurrent bacteraemia was less common after catheter removal and reinsertion than after salvage (8.1 vs 33.0%) but at the expense of dramatically more complications (14.3 vs 0.9%).…”

Cardiorenal Syndrome Type 4: A Review

“…The second mechanism is blood exposure to contaminants, which may be present in the dialysate and may cross the dialysis membrane by back-diffusion and back-filtration stimulating monocyte activation [27]. A third component concerns the possible presence of catheters or synthetic grafts with tunnel or exit site infection, which represents a source of infection and inflammation [28,29]. Additionally, fluid overload should also be considered an important cardiovascular risk factor responsible for extracellular volume expansion and ventricular enlargement [30,31].…”