Early onset catheter‐associated bacteremia (CAB)

Abstract

Bacteremia is a common complication for hemodialysis (HD) patients (pts) with an indwelling central venous catheter (CVC). We studied our experience with CAB and noted that CAB occurred at an average of 96 ± 98 days after CVC insertion. We wondered what percentage of CAB occurred in the first 21 days after CVC insertion and the spectrum of organisms. We prospectively collected data on all HD pts from 3 centers with a CVC who developed bacteremia between 1/1/03 and 8/31/04. Pts who developed CAB with an identifiable source of bacteremia were excluded. 131 episodes of CAB were identified; 34 (25.95%) occurred in ≤21 days. The mean ± SDEV age of the pts developing CAB > 21 days and ≤21 days was 63 ± 17 and 61.5 ± 15.4 years, respectively. Table 1 outlines the spectrum of organisms. There was a significantly greater incidence of CAB with Staphylococcus aureus(SA) and a significantly lower incidence of Staphylococcus epidermidis(SE) in the pts in whom a CAB developed ≤21 days after insertion. Table 1 <21 Days >21 Days P‐Value SA 20 (58.8%) 21 (21.6%) p < 0.01 SE 2 (5.9%) 30 (30.9%) p < 0.05 Other GP* 7 (20.6%) 15 (15.5%) NS GN^ 9 (26.5%) 40 (41.2%) NS *GP: gram‐positive; GN∧: gram‐negative We conclude that CAB occurs in the first 21 days after CVC insertion in 25% of our CVC pts. Pts developing CAB in the first 21 days are more likely to develop CAB with SA and less likely to develop CAB with SE than pts who develop CAB after 21 days. Empiric antibiotic choice and preventative strategies need to take these data into consideration.