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Catheter-Related Bacteremia and Outcome of Attempted Catheter Salvage in Patients Undergoing Hemodialysis
- Kieren A. Marr, MD;
- Daniel J. Sexton, MD;
- Peter J. Conlon, MB, FRCPI;
- G. Ralph Corey, MD;
- Steven J. Schwab, MD; and
- Kathryn B. Kirkland, MD
- From Duke University Medical Center, Durham, North Carolina. Acknowledgment: The authors thank Stephanie Weaver for assistance in data collection. Requests for Reprints: Kieren A. Marr, MD, University of Washington Medical Center, Division of Allergy and Infectious Diseases, Box 358080, Seattle, WA 98195. Current Author Addresses: Dr. Marr: University of Washington, Division of Allergy and Infectious Diseases, Seattle, WA 98195. Drs. Sexton, Corey, and Kirkland: Duke University Medical Center, Division of Infectious Diseases, Durham, NC 27705.
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.
- Copyright ©2004 by the American College of Physicians
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