A Retrospective Study into the Use of Prophylactic Antibiotics Pre-Central Venous Catheter Insertion and the Associated Patient Outcomes

Abstract

The risk of bloodstream infection is thought to be as much as 2-3 times more common in patients dialysing from a central venous catheter than those via a fistula. It is not uncommon practice for some nephrology units to use prophylactic antibiotics in the hope of preventing blood stream infections in many patients already with some degree of immunosuppression. As there is no specific guidance we therefore aim to look at the rates of infections in those who received and did not receive antibiotics and their outcomes to try and produce guidelines in relation to their use. 420 lines inserted were analysed over a course of 2 years, the data was analysed and groups divided into those who received antibiotics and those who had not. Those found to be infected were followed up further by analysis of old medical notes and medication prescription charts to see the action taken following a positive line culture and the outcomes associated. In total 97 (23%) patients didn't receive antibiotics and 323 (77%) did receive prophylactic antibiotics. Positive cultures in the antibiotics and non-antibiotics groups after exclusions of the patient septic prior to line insertion were therefore 9 (2.8%) and 5 (5.2%) respectively. No severe complications from line sepsis occurred in either group and all patients made a full recovery from each group. The risk of developing a catheter related infection leading to a significant event requiring ICU admission or death does not increase regardless of the use of prophylactic antibiotics pre-procedure.