title: Routine replacement of tunneled, cuffed, hemodialysis catheters eliminates paraspinal/vertebral infections in patients with catheter-associated bacteremia.
abstract: BACKGROUND
  Management of tunneled, cuffed, central venous catheters in hemodialysis (HD) patients with bacteremia remains a challenge. Attempts to salvage the catheter with systemic antibiotics alone have been associated with increased risk of metastatic infectious complications.
  
  
  METHODS
  Retrospective case series of patients with infectious complications in a chronic dialysis unit, affiliated with a tertiary care university hospital.
  
  
  RESULTS
  Between 1996 and 1999, when we treated HD catheter-associated bacteremia with systemic antibiotics alone, we encountered a clustering of 8 cases of paraspinal/vertebral infections in a population of 162 patients. After changing our protocol, i.e., routine catheter exchange over a guide wire at approximately 48 h, while on systemic antibiotic therapy, we did not encounter any new cases of paraspinal/vertebral infections over a 15-month period.
  
  
  CONCLUSIONS
  Our experience suggests that routine exchange of tunneled, cuffed catheters over a guide wire in HD patients presenting with bacteremia may significantly reduce serious infectious complications, e.g., epidural abscess/vertebral osteomyelitis.
authors.affiliation: Division of Nephrology, Saint Louis University Health Sciences Center, Saint Louis, MO 63110, USA. philipmd@slu.edu
authors.forename: Marie
authors.initials: M
authors.lastname: Philipneri
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Al-Aly
authors.forename: Kamal
authors.initials: K
authors.lastname: Amin
authors.forename: Mary E
authors.initials: ME
authors.lastname: Gellens
authors.forename: Bahar
authors.initials: B
authors.lastname: Bastani
mesh_terms: D016470:Bacteremia / Q000209:etiology / Q000628:therapy*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D020878:Device Removal; D015299:Discitis / Q000209:etiology / Q000517:prevention & control; D020802:Epidural Abscess; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000517:prevention & control; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*