Central venous dialysis catheters: catheter-associated infection.
Tunneled dialysis catheters (TDC) are extensively used for long-term venous hemodialysis access and their use is frequently associated with infectious complications. Catheter-related bacteremia (CRB) is the most common and important infection associated with TDC use and may be caused by a wide variety of Gram-positive or Gram-negative organisms. Prevention of CRB can be difficult despite use of rigorous infection-control techniques for catheter insertion and access. A number of antibacterial catheter-packing solutions hold promise for reduction of CRB. Treatment of CRB with antibiotics alone yields poor results and may increase the risk for other infectious complications, especially endocarditis. In selected cases where initial infection control can be achieved with antibiotics, guidewire exchange of the TDC results in cure rates equivalent to those of TDC removal and subsequent replacement. Dialysis programs should monitor TDC infections with attention to incidence, bacteriology, and outcomes.
Saad
T F
TF
Department of Medicine, Christiana Hospital, Newark, Delaware 19713, USA. tfsaad@aol.com
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D004866:Equipment Contamination; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D018570:Risk Assessment; D012307:Risk Factors
D000900:Anti-Bacterial Agents