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Dialysis catheter-related bacteremia: Treatment and prophylaxis

Dialysis catheter-related bacteremia: Treatment and prophylaxis,10.1053/j.ajkd.2004.07.005,American Journal of Kidney Diseases,Michael Allon

Dialysis catheter-related bacteremia: Treatment and prophylaxis   (Citations: 71)
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● Catheter-related bacteremia is a major cause of morbidity among hemodialysis patients. This article reviews the medical literature regarding the treatment and prophylaxis of catheter-related bacteremia. Bacterial biofilm that forms in the catheter lumen is the source of catheter-related bacteremia. Treatment with systemic antibiotics alone fails to definitively eradicate the infection in most patients. Catheter-related bacteremia can be managed by either catheter removal with delayed placement of a new catheter or exchange of the infected catheter with a new catheter over a guidewire. More recent studies suggested that instillation of an antibiotic-anticoagulant lock into the catheter lumen, as an adjunct to systemic antibiotic therapy, can cure approximately two thirds of catheter-related bacteremias without requiring catheter replacement. The frequency of catheter-related bacteremia may be reduced by using tunneled, rather than nontunneled, dialysis catheters and strict aseptic technique. In addition, several pharmacological measures may be useful for prophylaxis against catheter-related bacteremia. These include application of an antimicrobial ointment (mupirocin or polysporin (Pfizer, New York, NY)) to the catheter exit site or instillation of an antimicrobial solution (gentamicin or taurolidine) into the catheter lumen. Subcutaneous dialysis devices do not reduce the frequency of catheter-related bacteremia unless an antimicrobial solution is instilled into the device. The development and widespread adoption of effective approaches to the treatment and prophylaxis of catheter-related bacteremia will dramatically reduce the morbidity and economic burden associated with this complication. Am J Kidney Dis 44:779-791. © 2004 by the National Kidney Foundation, Inc.
Journal: American Journal of Kidney Diseases - AMER J KIDNEY DIS , vol. 44, no. 5, pp. 779-791, 2004
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    • ...5 events per 1,000 catheter-days in several studies...

    Michael Allon. DialysisAre prophylactic gentamicin catheter locks safe?

    • ...Serious adverse events following an episode of TCC bacteremia include recurrent bacteremia, requiring hospitalization, systemic antibiotic therapy, and removal, reinsertion or replacement of catheters. It increases patient morbidity and mortality and medical costs.In attempt to prevent infection, many methods have been explored. Catheter-related infection (CRI) may be reduced by using antimicrobial lock solutions [...

    Ping Zhanget al. Successful Prevention of Cuffed Hemodialysis Catheter-Related Infectio...

    • ...The majority of CRB episodes are relatively uncomplicated, but approximately 10% of patients with CRB are hospitalized with either severe sepsis (hemodynamic instability or high fever with shaking chills) or a metastatic infection such as endocarditis, osteomyelitis, septic arthritis, or epidural abscess [25]...
    • ...In addition, the Infectious Diseases Society of America has proposed that the colony count of the TCC blood culture should be more than five-fold greater than that of the peripheral vein [30], as a positive blood culture only from the TCC may simply represent colonization [25]...
    • ...Therefore, a positive result from a catheter needs clinical interpretation and may require confirmation [31], and the diagnosis of CRB in a patient with a positive blood culture only from the TCC should be considered as probable and not definite [25]...
    • ...In addition, it is considered imperative to obtain blood cultures 1 week after completing the antibiotic regimen to document that CRB has been resolved [25]...

    Constantinos J. Stefanidis. Prevention of catheter-related bacteremia in children on hemodialysis:...

    • ...Different mechanisms are thought to contribute to CRB: migration of bacteria from exit-site infections, contamination of the catheter hub and internal colonization of the catheter by organisms forming a biofilm [6,16]...

    Georgia Winnettet al. Trisodium citrate 46.7% selectively and safely reduces staphylococcal ...

    • ...lthough arteriovenous fistulas are the preferred vascular access for patients receiving long-term hemodialysis, central venous catheters remain a common form of access for many patients (1, 2). In North America, catheters are currently used in as many as 60% to 70% of incident and 30% to 40% of prevalent patients undergoing hemodialysis (1, 3). Catheter use is associated with increased patient morbidity and mortality, including a 10- to ...
    • ... access for patients receiving long-term hemodialysis, central venous catheters remain a common form of access for many patients (1, 2). In North America, catheters are currently used in as many as 60% to 70% of incident and 30% to 40% of prevalent patients undergoing hemodialysis (1, 3). Catheter use is associated with increased patient morbidity and mortality, including a 10- to 20-fold greater risk for bacteremia than with fistulas (2)...
    • ...The resulting 0.16 to 0.66 catheter-related bloodstream infection that occurs for every 100 catheter-days may partly explain the 2- to 3-fold increased risk for death associated with catheter use among patients undergoing hemodialysis (2, 4, 5)...
    • ...Techniques to reduce catheter-related infection risk include strict adherence to sterile technique and use of chlorhexidine or povidone‐iodine cleaning solutions with catheter care (2, 6, 7). Recent strategies to further reduce catheter-related infection rates include use of antibiotic ointments applied around the catheter exit site and antibiotics locked in the intraluminal portion of the catheter between dialysis sessions...
    • ...population undergoing hemodialysis (1, 2), even 50% uptake of topical antibiotic use in prevalent hemodialysis patients might prevent as many as 37 000 episodes of bloodstream infection per year...
    • ...One reason is the potential for development of antimicrobial resistance and speculation that this may lead to the emergence of drug-resistant bacterial isolates and loss of efficacy over time (8, 34)...
    • ...Mupirocin resistance has been reported in other settings (35‐37), and although isolation of antibiotic-resistant isolates was not observed in the RCTs that included monitoring for drug-resistant organisms, longer durations of exposure may be needed for resistance to evolve (15, 34)...
    • ...Society of Nephrology (7) have recommended the use of a topical antibiotic for prophylaxis, the 2006 update to the vascular access guidelines of the National Kidney Foundation Dialysis Outcomes Quality Initiative refrained from making such a recommendation (2)...

    Matthew T. Jameset al. Meta-analysis: Antibiotics for Prophylaxis against Hemodialysis Cathet...

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