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Ann Intern Med. 1997 Aug 15;127(4):275-80.

Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis.

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1
Duke University Medical Center, Durham, North Carolina, USA.

Abstract

BACKGROUND:

Dual-lumen cuffed catheters are used for vascular access in patients undergoing hemodialysis. The incidence and appropriate management of catheter-related bacteremia are unknown.

OBJECTIVE:

To determine the incidence and outcome of catheter-related bacteremia and to assess the efficacy of catheter salvage.

DESIGN:

Prospective, observational study.

SETTING:

University hospital inpatient service and four affiliated outpatient dialysis units.

PATIENTS:

102 patients with end-stage renal disease who underwent hemodialysis with dual-lumen cuffed catheters between 1 April 1995 and 1 January 1996.

MEASUREMENTS:

Number of days that the catheter remained in situ, treatment (catheter removal or attempted salvage with antibiotic therapy), and outcome of bacteremia. Microbiological cultures were done to identify catheter-related bacteremia.

RESULTS:

102 patients had a total of 16,081 catheter-days. Forty-one patients (40%) developed 62 episodes of bacteremia (3.9 episodes per 1000 catheter-days [95% CI, 3.0 to 4.9 episodes per 1000 catheter-days]). Twenty-four catheters (39%) were removed immediately, and 38 (61%) were left in place during treatment. Only 12 (32%) of the 38 catheters were salvaged successfully. Salvage was less likely to succeed in patients with gram-positive bacteremia than in patients with gram-negative bacteremia, but this difference was not statistically significant (P = 0.14). Nine of the 41 patients (22%) who developed bacteremia had the following complications: osteomyelitis (6 patients), septic arthritis (1 patient), infective endocarditis (4 patients), and death (2 patients). All complications followed an episode of gram-positive bacteremia, and none was associated with attempted catheter salvage.

CONCLUSIONS:

Bacteremia frequently occurs in patients undergoing hemodialysis with dual-lumen catheters. Antibiotic therapy without catheter removal is unlikely to eradicate catheter-related bacteremia in these patients, but attempted salvage may not increase the risk for complications.

[Indexed for MEDLINE]

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