Abstract
Central vein catheters (CVC) are an important means of delivering hemodialysis (HD) to patients who require immediate initiation of dialysis but are without a mature functioning arterio-venous fistula or graft. The frequency of catheter-related bacteremia (CRB) reported in several large series ranged between 2.5 and 5.5 cases/1,000catheter-days. The aim of the study was to evaluate the incidence, spectrum of infecting organisms, risk factors, and optimal treatment for catheter-related bacteremia.This retrospective study of clinical records was conducted between January 2005 and January 2009 where all episodes of catheter related bacteremia in the preceding 4 years were a subject of our study. Data recorded for each patient included the number of catheter-days, episodes of suspected bacteremia, blood culture results, method of treatment, complications, and outcomes. All patients with CRB were treated with a 21-day course of intravenous antibiotics, with surveillance cultures obtained 1 week after completing the course of antibiotics. The CVC was removed if the patient had uncontrolled sepsis or if other vascular access was ready for use. Once the infection was controlled, catheter salvage was considered successful, leaving the original CVC in place. 93 chronic hemodialysis (HD) patients, 42 male (45.25%) and51 female (54.8%) were included, with median age51.67 years. During this study, there were 37087catheter-days, with 52 episodes of CRB, or 1.4 episodes/1,000 catheterdays. Thirty- five infections (67.3%) were caused by gram-positive cocci only, including Staphylococcus aureus, Staphylococcus simulans, and Staphylococcus haemolyticus. Seventeen infections (32.7%) were caused by gram-negative rods only, including a wide variety of enteric organisms. Five CVCs were removed because of severe uncontrolled sepsis, of the remaining 47 cases; attempted CVC salvage was successful in (90.3%). The only important complication of CRB was endocarditis, occurring in 1 of 52 episodes (1.9%). We conclude that in our study, CRB is relatively near the lower limit of normal range with low incidence of complication and frequently involves gram-positive bacteria. CVC salvage is significantly improved when CVC was treated by antibiotic based on blood culture results.
Highlights
Central venous catheters (CVC) are an important means of delivering hemodialysis (HD) to patients who require immediate initiation of dialysis but are without a mature functioning arterio-venous fistula or graft
The study included 93 chronic hemodialysis (HD) patients from Prince Salman Center for Kidney Diseases (PSCKD), they were 42 male patients (45.2%) and 51female patients (54.8%), Data recorded for each patient included the number of catheter-days, episodes of suspected bacteremia, blood culture results, method of treatment, complications, and outcomes
The diagnosis of Catheter-related bacteremia was established when a hemodialysis patient with a dialysis catheter has: 1- Clinical symptoms: fever or chills, unexplained hypotension, malaise, nausea, changes in mental status, hypothermia, lethargy, hypoglycemia, or diabetic ketoacidosis. 2- No other source of infection. 3- Definitive diagnosis of catheter-related bacteremia was made when blood cultures obtained from both the catheter lumen and a peripheral vein grow the same organism (2), and there was no difference regarding the infecting organism between blood cultures drawn from the catheter or a peripheral vein if the cultures are drawn during the dialysis
Summary
Central venous catheters (CVC) are an important means of delivering hemodialysis (HD) to patients who require immediate initiation of dialysis but are without a mature functioning arterio-venous fistula or graft. The risk of developing bacteremia varies with site of CVC insertion; type of device and duration of CVC use. The aim of the study was to evaluate the incidence, spectrum of infecting organisms, and optimal treatment for catheter-related bacteremia Treatment. Our protocol for treatment of CRB once it is diagnosed consisted of initial empiric antibiotic regimen included both vancomycin (20 mg /kg /weekly) and broad-spectrum gram-negative bacterial coverage (third-generation cephalosporin) Ceftazidime (1g post every session). Protocol success, was defined as catheter salvage plus resolution of symptoms within 48 h of initiation of therapy and negative cultures 1 week after completion of the regimen. The PC was removed if the patient had uncontrolled sepsis, haemodynamically unstable, or if other vascular access was ready for use
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