LETTER
Catheter-Related Bacteremia in Patients Undergoing Hemodialysis
Josep A. Capdevila, MD;
Alfons Segarra, MD; and
Albert Pahissa, MD
1 April 1998 | Volume 128 Issue 7 | Page 600
TO THE EDITOR:
In the article on the advisability of maintaining an infected catheter in patients who are undergoing hemodialysis and have catheter-related bacteremia [1], Marr and colleagues report that only 12 catheters (19%) in 62 episodes of bacteremia were salvaged successfully. This contrasts with our experience, previously published [2] and later re-evaluated [3], showing high success rates in treating catheter-related bacteremia without catheter removal. During a 41-month period, 37 of 185 patients with a central venous catheter implanted for hemodialysis had a total of 42 episodes of catheter-related bacteremia. This represents 1.3 episodes per 1000 days of catheterization. According to strict inclusion criteria, 40 of 42 episodes were successfully treated and showed no septic complications during extended follow-up (mean, 20.5 months [range, 2 to 44 months]).
We believe that some points in the authors' evaluation of conservative management of catheter-related bacteremia need to be clarified. First, the authors did not discuss results of catheter-tip culture in withdrawn catheters. In our patients, bacteremia was confirmed by quantitative blood culture [4], and removed catheters were microbiologically assessed to confirm catheter colonization or cure. Second, when Marr and colleagues attempted catheter salvage, they administered only antibiotics to treat bacteremia; they did not sterilize the catheter. Patients having hemodialysis are given low doses of antibiotics because of renal failure. In this situation, the catheter is briefly in contact with the frequently given antibiotic only once a week. We used the antibiotic-lock technique to achieve high concentrations of antibiotics within the catheter during the interdialysis period.
Conservative management of catheter-related bacteremia in patients who need permanent vascular access is a strategy that implies considerable benefits. To evaluate the advisability of this strategy, each case must be strictly defined. Attempts should be made to sterilize the catheter while bacteremia is being treated.
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Author and Article Information
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Hospital Vall d'Hebron; 08035 Barcelona, Spain
1. Marr KA, Sexton DJ, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med. 1997; 127:275-80.
2. Capdevila JA, Segarra A, Planes AM, Ramirez-Arellano M, Pahissa A, Piera L, et al. Successful treatment of haemodialysis catheter-related sepsis without catheter removal. Nephrol Dial Transplant. 1993; 8:231-4.
3. Capdevila JA, Segarra A, Planes AM, Gasser I, Gavalda J, Pahissa A. Long term follow-up of patients with catheter related sepsis (CRS) treated without catheter removal [Abstract]. In: Program and Abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco. Washington, DC: American Society for Microbiology: 1995.
4. Capdevila JA, Planes AM, Palomar M, Gasser I, Almirante B, Pahissa A, et al. Usefulness of quantitative blood culture for diagnosis of catheter related sepsis. Eur J Clin Microbiol. 1992; 11:403-7.
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