Dialysis catheter-related bacteremia: treatment and prophylaxis.
Catheter-related bacteremia is a major cause of morbidity among hemodialysis patients. This article reviews the medical literature regarding the treatment and prophylaxis of catheter-related bacteremia. Bacterial biofilm that forms in the catheter lumen is the source of catheter-related bacteremia. Treatment with systemic antibiotics alone fails to definitively eradicate the infection in most patients. Catheter-related bacteremia can be managed by either catheter removal with delayed placement of a new catheter or exchange of the infected catheter with a new catheter over a guidewire. More recent studies suggested that instillation of an antibiotic-anticoagulant lock into the catheter lumen, as an adjunct to systemic antibiotic therapy, can cure approximately two thirds of catheter-related bacteremias without requiring catheter replacement. The frequency of catheter-related bacteremia may be reduced by using tunneled, rather than nontunneled, dialysis catheters and strict aseptic technique. In addition, several pharmacological measures may be useful for prophylaxis against catheter-related bacteremia. These include application of an antimicrobial ointment (mupirocin or polysporin [Pfizer, New York, NY]) to the catheter exit site or instillation of an antimicrobial solution (gentamicin or taurolidine) into the catheter lumen. Subcutaneous dialysis devices do not reduce the frequency of catheter-related bacteremia unless an antimicrobial solution is instilled into the device. The development and widespread adoption of effective approaches to the treatment and prophylaxis of catheter-related bacteremia will dramatically reduce the morbidity and economic burden associated with this complication.
Allon
Michael
M
Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA. mdallon@uab.edu
D019072:Antibiotic Prophylaxis / Q000379:methods*; D016470:Bacteremia / Q000188:drug therapy* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology*; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D016712:Mupirocin / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects*; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013829:Thiadiazines / Q000627:therapeutic use*
D005839:Gentamicins; D013829:Thiadiazines; D013654:Taurine; C012566:taurolidine; D016712:Mupirocin