Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis.
Tunneled central venous catheters are often used in children on chronic hemodialysis. This study was done to evaluate the spectrum of catheter-related bacteremia (CRB) and to determine predictors of recurrent CRB in children on hemodialysis. Chart review was performed in 59 children from a pediatric dialysis unit with chronic, tunneled, cuffed hemodialysis catheters between January 1999 and December 2003. CRB was diagnosed in 48 of 59 (81%) patients. The incidence of CRB was 4.8/1,000 catheter days. Overall catheter survival (290+/-216 days) was significantly longer than infection-free catheter survival (210+/-167 days, p<0.05). Organisms isolated were gram-positive in 67%, gram-negative in 14%, and polymicrobial in 19%. Systemic antibiotics cleared CRB in 34% and an additional 23% cleared with the inclusion of antibiotic-heparin locks; 43% required catheter exchange. There was a significant likelihood of early catheter exchange with polymicrobial CRB (p<0.01). Catheter loss occurred from infection in 63%. Risk factors for CRB included young age (<10 years) and presence of human immunodeficiency virus (HIV) infection. Patients with >2 initial positive blood cultures (p<0.0001) had a significantly higher rate of recurrence after 6 weeks of initial treatment. In conclusion, CRB remains a major determinant of catheter loss. However, overall catheter survival is longer than infection-free catheter survival, suggesting that systemic antibiotics with antibiotic-heparin locks should be the initial step in the management of CRB and this approach may salvage some catheters.
Onder
Ali Mirza
AM
Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children's Hospital, University of Miami, Miami, FL 33101, USA.
Chandar
Jayanthi
J
Coakley
Sheila
S
Abitbol
Carolyn
C
Montane
Brenda
B
Zilleruelo
Gaston
G
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology*; D002404:Catheterization / Q000009:adverse effects*; D002648:Child; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents