Hemodialysis Catheter–Related Bacteremia in Children: Increasing Antibiotic Resistance and Changing Bacteriological Profile

Araya, Carlos E.; Fennell, Robert S.; Neiberger, Richard E.; Dharnidharka, Vikas R.

doi:10.1053/j.ajkd.2007.04.005

Cited by 18 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The majority of these children receive HD therapy (1,3,12,13). Major improvements in HD equipment and techniques and the accumulating experience in HD therapy of the young have led to a growing number of infants receiving this mode of extracorporeal therapy (4,5,9,15).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, data on CVC infection rates and survival times in children on HD therapy are scarce. Several studies (4,(7)(8)(9)(10)(11)(12) (Table 1) have reported a rate of bacterial infection in CVCs used for HD in children with ESRD in the range of 1.5 to 4.8 episodes/1000 catheter days. Reported CVC survival times have varied between 84 and 290 days (4,(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low Infection Rates and Prolonged Survival Times of Hemodialysis Catheters in Infants and Children

Eisenstein

Tarabeih

Magen

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives Hemodialysis (HD) catheter-related complications are regarded as the main cause of HD failure in infants and children with ESRD. In this study, we determined HD catheter infection rates and survival times in children. Results Twenty-nine children with ESRD (median age, 10 years) received HD through a CVC, for a total of 22,892 days during the study period. Eleven (38%) children were infants (Ͻ1 year of age) who received HD for a cumulative 3779 days (16% of total). Fifty-nine CVCs were inserted, of which 13 (22%) were in infants. There were 12 episodes of CVC infection-a rate of 0.52/1000 CVC days. Four (33%) episodes occurred in infants-a rate of 1.06/1000 CVC days. Only three (5%) of the CVCs were removed because of infection. Median catheter survival time for all children was 310 days and for infants was 211 days.Conclusions Very low CVC infection rates (one infection per 5 CVC years) and prolonged CVC survival times (around 1 year) are achievable in infants and children with ESRD receiving HD therapy by adhering to a strict catheter management protocol and without using prophylactic antibiotic therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low Infection Rates and Prolonged Survival Times of Hemodialysis Catheters in Infants and Children

Eisenstein

Tarabeih

Magen

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Our data supported this concept for the catheter replacement group but found little or no microbiology effect in those who were selected for salvage. This may reflect the gradually reducing incidence of this organism over time and documented shift toward other Gram-positive and Gram-negative infections (7,9) and suggests that initial management decisions can be made clinically, before the microbiological isolate is known.…”

Section: Discussionmentioning

confidence: 99%

“…A bacteremia frequency of 3.9 episodes per 1000 catheter days was typical in older studies (7), whereas rates of 1.7 to 2.2 per 1000 catheter days have been reported more recently (8,9). A rate of one episode per 1000 catheter days is now considered achievable with optimal practice, including prompt recognition and treatment of exit-site infection (10), as was found in a recent metaanalysis of studies that used topical prophylaxis (11).…”

mentioning

confidence: 95%

Bacteremia Associated with Tunneled Hemodialysis Catheters

Ashby¹,

Power²,

Singh³

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

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.

show abstract

“…An example could be to initially use both intravenous vancomycin and ciprofloxacin until the gram stain/culture is available, when the treatment can be modified accordingly. However, antibiotic policy will depend on local resistance patterns, which are changing, with the emergence of more resistant organisms being seen [47]. It is wise to use antifungal prophylaxis when broad-spectrum antibiotics are used.…”

Section: Infection In Vascular Cathetersmentioning

confidence: 99%