Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections

Martin, Kylie; Lorenzo, Yves S Poy; Leung, Po Yee Mia; Chung, Sheri; O'Flaherty, E.; Barker, N.; Ierino, Francesco L.

doi:10.1093/ofid/ofaa117

Cited by 18 publications

(20 citation statements)

References 10 publications

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“…Gram positive organisms are responsible for most CRBSI episodes associated with TCCs (40–84% cases). 16 Our CRBSI microbiology results are consistent with the international literature since gram-positive organisms were the most prevalent isolates (60.4%) (Figure 4). However, Candidemia was found in a significant proportion of patients (26%).…”

Section: Discussionsupporting

confidence: 90%

“…Recently Martin et al from Melbourne, Australia published their findings that presence of diabetes and left internal jugular vein insertion site were independent risk factors for CRBSI. 16 Seventeen percent of the TCCs in their study were associated with CRBSI leading to removal of catheter in 16% cases. Castro et all reported a higher infection rate associated with TCCs (29.6%), with the mean catheter duration of 333 days explaining the higher frequency of infection.…”

Section: Discussionmentioning

confidence: 92%

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Outcomes of tunneled cuffed hemodialysis catheters: An experience from a tertiary care center in Karachi, Pakistan

et al. 2021

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Introduction: Tunneled cuffed catheters (TCC) are generally used as a temporary means to provide hemodialysis (HD) until permanent arteriovenous access is established. However, certain complications are associated with use of TCCs such as infections, catheter malfunction/malposition or venous stenosis. Limited data is available on outcomes and long term complications associated with TCCs in our country. The aim of this study was to study the outcomes of TCCs and associated long term complications during the course of its usage. Methods: We retrospectively studied case records of patients who had TCCs placed for HD at our institution, from January 2016 to June 2018. Results: A total of 116 TCCs were placed during the study period. The mean age of the population was 57.09 years; 58.6% were males. The right internal jugular vein (52.6%) was the most common site of TCC insertion followed by the left internal jugular vein (29.3%). Functioning TCCs were successfully removed in almost two-thirds of cases (65.7%) once their permanent access was mature. Development of catheter related blood stream infection (CRBSI) was seen in 22 patients (19.8%) requiring catheter removal in 14 (12.6%) patients. Mechanical complications leading to catheter removal were seen in seven patients (6.3%). The median catheter duration was 62.5 days ranging from 1 to 343 days. Conclusion: TCCs, though associated with complications particularly CRBSI, are a viable option for short- to intermediate-term use for HD till the maturation of permanent arteriovenous access in a limited-resource setting.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 92%

Outcomes of tunneled cuffed hemodialysis catheters: An experience from a tertiary care center in Karachi, Pakistan

et al. 2021

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“…Variation in infection rate among different studies could be due to multiple causes, mainly because of differed health settings and patients' attitude. Previously conducted studies reported that risk of CRBSI was signi cantly higher among patients with catheter placement from left internal jugular vein, diabetes, increasing catheter duration [31,32]. However, in the current study no signi cant association of any factor was determined with CRI.…”

Section: Discussioncontrasting

confidence: 69%

Outcomes of Tunneled Dialysis Catheter In Hemodialysis Patients In A Tertiary Care Hospital

Tahir

Ali

Siddiqui

et al. 2022

Preprint

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BACKGROUND: To evaluate tunnel dialysis catheter (TDC) patency and its outcome among patients receiving TDC in a tertiary care hospital.METHODS: Retrospectively patients’ records were reviewed who underwent TDC placement during February 2016 to November 2020 at Department of Interventional Radiology, Liaquat National Hospital, Karachi, Pakistan. Patients’ age, gender, residence, comorbidity, catheter placement site, use of antibiotics before catheter insertion, reasons for catheter removal and total catheter days were retrieved from patients’ medical record file.RESULTS: 130 patients received TDC with a median follow-up of 148 (inter-quartile range: 60.8 – 274.3) days. 94(72.3%) catheters were electively removed whereas 18(13.8%), 16(12.3%) and 2(1.5%) catheters were removed due to infections, blockage and physical damage respectively. None of the mortality was observed due to catheter related complication. The incidence of overall infection, bacteremia and other infections during one year was 7.3, 5.01 and 3.19 per 10,000 patient-days respectively. Infection free survival rate was 68% with mean time to infection was 676.63 (95% CI: 593.87 – 759.39) days. During the study, total catheter patency was 53.2%. None of the patients’ characteristics was associated with catheter related infections and catheter patency.CONCLUSION: TDCs are the best available alternative for short to intermediate term use for hemodialysis when all preventive measures are taken to avoid catheter related complications either infectious or non-infectious until permanent dialysis access is achieved or renal transplant is done. It may also serve as long term hemodialysis mode in patients in whom permanent access or transplant is not preferred.

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“…While it has been lately reported by Quinn et al, in one Canadian study, that CRBSIs culminated into death of 2.3% of their cohort, 39 Farrington and Allon affirmed that only 1% of the recorded mortality between their catheter-reliant hemodialysis patients was ascribed to CRBSI. 37 Recently, a substantively higher mortality rate up to 5% was specified by Martin et al 40 In contrast, although 2.16% of our hemodialysis patients died during the 2 years-study period, mortality could not be allocated directly to CRBSI, denoting that the use of hemodialysis catheters was not a leading cause of death per se amongst our cohort.…”

Section: Discussionmentioning

confidence: 66%

Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study

El-Kady¹,

Waggas²,

Akl³

2021

IDR

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Background Albeit growing technical advances in the design of hemodialysis catheters, intravascular catheter-related bloodstream infection (CRBSI) still represents an utmost clinical challenge to the health-care workers (HCWs). Data regarding the influence of the culprit organism on the scenario of CRBSI in the literature are extremely lacking. Thereby, this research was carried out. Methods We undertook a retrospective cohort study over an interval of 2 years, involving patients who underwent regular hemodialysis via catheters in the Renal Dialysis Unit (RDU) of Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Kingdom of Saudi Arabia (KSA). The study enrolled 139 patients (56.8% females and 43.2% males), with mean age of 60.79 ± 11.45 years. Results The aggregate rate of CRBSI was 5.1/1000 catheter days. Amongst the 139 study candidates confirmed of having CRBSI, while 69.8% of CRBSIs were ascribed to Gram-positive cocci, about one-third of the infectious episodes were secondary to Gram-negative bacilli. Interestingly, fever was the most common presentation of S. aureus CRBSI compared to CoNS and Gram-negative bacilli CRBSIs (20.9% versus 12.9% versus 6.5%, p = 0.0001), whereas CRBSIs due to CoNS were presented mainly with rigors (19.4%). Of note, CRBSIs caused by Gram-negative bacilli had a tendency to manifest with unusual symptoms such as vomiting or hypotension. Besides, they were more prone to involve hospitalization or ICU admission. In this study, no mortality was attributed to CRBSIs. Conclusion Our study disclosed that the illicit organism has a repercussion on the clinical presentation as well as the fate of CRBSI among hemodialysis patients. This highlights the worth of identifying the infected cases in a periodic manner, to avoid the occurrence of devastating complications. A large body of work from various hemodialysis centers should take place in the near future so as to provide more insight in this perspective.

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Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections

Abstract: Diabetes and left internal jugular vein insertion site were significantly associated with increased risk of a catheter-related bloodstream infection from a tunneled hemodialysis catheter. Ex-smoker status was significantly associated with reduced risk.

Cited by 18 publications

References 10 publications

Outcomes of tunneled cuffed hemodialysis catheters: An experience from a tertiary care center in Karachi, Pakistan

Outcomes of tunneled cuffed hemodialysis catheters: An experience from a tertiary care center in Karachi, Pakistan

Outcomes of Tunneled Dialysis Catheter In Hemodialysis Patients In A Tertiary Care Hospital

Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study

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