title: Hemodialysis catheter-related bacteremia in children: increasing antibiotic resistance and changing bacteriological profile.
abstract: BACKGROUND
  Catheter-related infections limit catheter survival. The success of antimicrobial therapy for the treatment of patients with hemodialysis catheter-related bacteremia (HD-CRB) depends on the infectious organisms. We determined whether the rate of positive blood culture results per tunneled catheter-days, the spectrum of bacterial isolates, and their antibiotic susceptibility changed over time in our pediatric dialysis unit.
  
  
  METHODS
  Data were collected retrospectively for all positive blood culture results from long-term hemodialysis patients in our pediatric unit from July 1990 to July 1995 (period A) and July 2000 to July 2005 (period B).
  
  
  RESULTS
  Rates of HD-CRB were similar between periods A and B (2.1 versus 2.2/1,000 catheter-days). In period A, 33% of isolates were coagulase-positive staphylococci, with Staphylococcus aureus accounting for 72% of these. In period B, the most common organism was Staphylococcus epidermidis (28%), whereas coagulase-positive staphylococci were identified in only 17%. There was a larger number of gram-positive bacilli in period B (20%) compared with period A (4%). A significant decrease in susceptibility to penicillins (40% to 5%; P = 0.007) and cephalosporins (58% to 21%; P = 0.04), but not aminoglycosides, was noted for gram-positive bacteria. There was no significant change in susceptibility of gram-negative bacteria to cephalosporins and aminoglycosides in either period.
  
  
  CONCLUSIONS
  Both types of organism and antibiotic sensitivity patterns have changed over time. Based on these data, we changed our empiric antibiotic combination for HD-CRB to vancomycin plus an aminoglycoside.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610-0296, USA.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Araya
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fennell
authors.forename: Richard E
authors.initials: RE
authors.lastname: Neiberger
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002648:Child; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification