title: Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis.
abstract: 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.
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children's Hospital, University of Miami, Miami, FL 33101, USA.
authors.forename: Ali Mirza
authors.initials: AM
authors.lastname: Onder
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Chandar
authors.forename: Sheila
authors.initials: S
authors.lastname: Coakley
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
authors.forename: Brenda
authors.initials: B
authors.lastname: Montane
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents