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

Vanholder, Raymond; Canaud, Bernard; Fluck, Richard C.; Jadoul, Michel; Labriola, Laura; Martí-Monrós, Anna; Tordoir, Jan H.M.; Biesen, Wim Van

doi:10.1093/ndtplus/sfq041

Cited by 87 publications

(131 citation statements)

References 85 publications

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“…In this patient who is undergoing hemodialysis with a central venous catheter with no other localizing symptoms and signs, bacteremia is highly likely to be resulting from a catheter-related bloodstream infection. The Infectious Disease Society of America has published clinical practice guidelines for the diagnosis of catheter-related bloodstream infection, and they include the presence of one of the following criteria: (1) isolation of the same organism from at least one percutaneous blood culture and the tip of the catheter; (2) two cultures, one from the catheter hub and one from a peripheral vein, meeting the criteria for quantitative cultures (colony count from catheter hub more than threefold higher than peripheral vein) or differential time to positivity (bacterial growth in sample from [4][5][6]. These guidelines are consistent with findings of high rates of treatment failure and mortality in individuals with catheter-associated bloodstream infection when attempts are made to salvage the catheter (7).…”

Section: Discussion Of Questionmentioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2012

Mehrotra

Glassock

Bleyer

2013

Clinical Journal of the American Society of Nephrology

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SummaryPresentation of the Nephrology Quiz and Questionnaire has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, with the answers of program directors of nephrology training programs in the United States acquired through an Internet-based questionnaire. Topics presented here include fluid and electrolyte disorders, glomerular diseases, transplantation, and ESRD and dialysis. Cases representing each of these categories along with single best answer questions were prepared by a panel of experts (Drs. Palmer, Fervenza, and Brennan and Mehrotra, respectively). The correct and incorrect answers then were briefly discussed after the audience responses, and the results of the questionnaire were displayed. This article tries to recapitulate the session and reproduce its educational value for a larger audience-the readers of the CJASN.

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Section: Discussion Of Questionmentioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2012

Mehrotra

Glassock

Bleyer

2013

Clinical Journal of the American Society of Nephrology

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“…There is relatively little research on CLABSI in dialysis patients; nevertheless, several authorities have issued guidelines concerning the prevention of (dialysisassociated) CLABSI, including the CDC, SHEA and the ERA [2,3,8] . Major recommendations are summarized in table 1 .…”

Section: Preventionmentioning

confidence: 99%

“…The subclavian site should be avoided due to the risk of stenosis formation, which may only manifest after AVF creation [3] . No significant differences in CLABSI rates were found between IJV and FV with short-term dialysis (median 5 days).…”

Section: Insertion Sitementioning

confidence: 99%

“…Recommendations for diagnosis and management of CLABSIs associated with HD catheters are based on IDSA [33] and ERBP [3] guidelines. Local signs may include erythema, warmth, swelling, tenderness, and purulent discharge, and may be found both in exit site infections and in BSIs, although the absence of local signs does not rule out bacteremia.…”

Section: Management Of Bsismentioning

confidence: 99%

“…Between one and two third of HAIs are thought to be preventable [1] , which would translate into ten thousands of saved lives and billions of dollars in expenses avoided in US hospitals alone each year. A number of entities such as the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), the European Renal Association (ERA), and also the patient safety-oriented Institute for Healthcare Improvement (www.ihi.org) therefore publish HAI prevention guidelines to advance implementation of best practices [2,3] . The incidence of central line-associated bloodstream infections (CLABSIs), which exhibit higher mortality than most other HAIs, may drop to rates as low as zero with a robust infection prevention program [4] .…”

Section: Introductionmentioning

confidence: 99%

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Nosocomial Infections in Dialysis Access

Schweiger

Trevino²,

Marschall³

2015

Contributions to Nephrology

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Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central lineassociated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus , enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives.

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