Treatment of Dialysis Catheter–Related Staphylococcus aureus Bacteremia With an Antibiotic Lock: A Quality Improvement Report

Maya, Ivan D.; Carlton, Donna; Estrada, Erin; Allon, Michael

doi:10.1053/j.ajkd.2007.04.014

Cited by 98 publications

(68 citation statements)

References 22 publications

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“…Another potential weakness is that locking solutions, which have been found to improve outcomes in some previous studies (21)(22)(23), were not used for treatment in this study; treatment failures might therefore have been further reduced.…”

Section: Discussionmentioning

confidence: 93%

Bacteremia Associated with Tunneled Hemodialysis Catheters

Ashby¹,

Power²,

Singh³

et al. 2009

Clinical Journal of the American Society of Nephrology

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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.

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Section: Discussionmentioning

confidence: 93%

Bacteremia Associated with Tunneled Hemodialysis Catheters

Ashby¹,

Power²,

Singh³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Serious metastatic infections occur more frequently in patients with infections due to Staphylococcus aureus. The reported incidence with S. Aureus ranges from 10 to 45 percent (4,5). Soft tissue abscesses are seen rarely when compared with other complications.…”

Section: Discussionmentioning

confidence: 99%

Multiple Soft Tissue Abscesses in Peritoneal Dialysis Patient

Tanirli¹,

Katipoğlu²,

Ünal³

et al. 2016

Turk Neph Dial Transpl

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A 55-year-old had been undergoing continuous ambulatory peritoneal dialysis. He was admitted to our hospital for nausea-vomiting and back pain that was located at the interscapular area. Urine culture was positive for methicillin-resistant Staphylococcus aureus (MRSA) and purulent secretion from the diabetic foot grew MRSA. Also, the interscapular area abscess and peripheral blood cultures were positive MRSA. We report a case of multiple abscesses of methicillin-resistant Staphylococcus aureus (MRSA) at atypical locations in a immunsupressed patient on peritoneal dialysis.

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“…When a patient had two or more episodes of catheter-related candidemia, only the first episode was analyzed. We excluded from our analysis 13 patients with concurrent Staphylococcus aureus bacteremia, because this organism is associated with a high frequency of treatment failure (17). The remaining 40 patients with dialysis catheter-related candidemia were the focus of this study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Dialysis Catheter–Related Candidemia in Hemodialysis Patients

Sychev

Maya

Allon

2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Candidemia is a rare complication in catheter-dependent hemodialysis patients. As a result, there is uncertainty about its optimal medical management. The goal of this retrospective study was to compare the clinical outcomes of catheter-related candidemia managed with two different strategies: Guidewire exchange of the infected catheter versus removal with delayed replacement.Design, setting, participants, & measurements: We retrospectively queried a prospective, computerized vascular access database to identify 40 hemodialysis patients with catheter-related candidemia. All patients underwent treatment with antifungal medications for 2 wk, in conjunction with guidewire catheter exchange or catheter removal with delayed replacement. The primary outcomes were major complications, recurrent candidemia, and patient survival.Results: Candidemia represented approximately 2% of all cases of catheter-related bloodstream infections. Of the 40 patients with candidemia, 27 underwent guidewire catheter exchange and 13 had prompt catheter removal with delayed replacement. The two treatment groups were similar in demographic, clinical, and catheter characteristics. Only 1 (2.5%) patient developed a serious complication (endophthalmitis). Recurrence of candidemia within 3 mo was observed in 15% of each treatment group. Patient survival at 6 mo was similar in both groups.Conclusions: Catheter-related candidemia is rare in hemodialysis patients and has a low complication rate. Catheter exchange over a guidewire in conjunction with antifungal therapy is an effective and safe treatment regimen.

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Treatment of Dialysis Catheter–Related Staphylococcus aureus Bacteremia With an Antibiotic Lock: A Quality Improvement Report

Cited by 98 publications

References 22 publications

Bacteremia Associated with Tunneled Hemodialysis Catheters

Bacteremia Associated with Tunneled Hemodialysis Catheters

Multiple Soft Tissue Abscesses in Peritoneal Dialysis Patient

Clinical Outcomes of Dialysis Catheter–Related Candidemia in Hemodialysis Patients

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