title: Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis.
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.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University hospital inpatient service and four affiliated outpatient dialysis units.
  
  
  METHODS
  102 patients with end-stage renal disease who underwent hemodialysis with dual-lumen cuffed catheters between 1 April 1995 and 1 January 1996.
  
  
  METHODS
  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.
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Marr
authors.forename: D J
authors.initials: DJ
authors.lastname: Sexton
authors.forename: P J
authors.initials: PJ
authors.lastname: Conlon
authors.forename: G R
authors.initials: GR
authors.lastname: Corey
authors.forename: S J
authors.initials: SJ
authors.lastname: Schwab
authors.forename: K B
authors.initials: KB
authors.lastname: Kirkland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D012008:Recurrence; D006435:Renal Dialysis; D012306:Risk; D016896:Treatment Outcome