title: Impact of tip culture on the management of infected tunneled hemodialysis catheters.
abstract: OBJECTIVE
  It is common practice to perform culture of the tip of a catheter when a previously indwelling vascular catheter is removed for presumed infection. This study was conducted to determine the effect of hemodialysis catheter tip cultures (CTCs) on patient management.
  
  
  METHODS
  Patients whose tunneled hemodialysis catheter (TDC) was removed for infection and who had a CTC between July 2001 and June 2006 were identified. The study sample included 242 patients with 330 catheters (109 men, 133 women). Patients' mean age was 58 years (range, 22-94 y). Catheter tip and blood culture (BC) results obtained during the event leading to catheter removal were recorded. Antimicrobial therapy before and after cultures was recorded. Medical records were reviewed for any indication that the treatment plan was influenced by tip culture results.
  
  
  RESULTS
  Of 330 catheters, 134 had positive CTC findings; of these, complete records were available for 52 catheters. The treatment plan for patients with suspected catheter-related bloodstream infection (CRBSI) leading to TDC removal did not change in response to semiquantitative CTC results (51 of 52 patients; 98%). In a single case in which CTC results impacted management, this was because of a delay in processing BCs. Negative CTC findings (n = 108) never changed management (ie, resulted in cessation of antibiotic therapy). Seventy-three percent of patients (n = 38) received empiric antibiotics before any culture results. In these cases, the BC susceptibility profiles confirmed the appropriateness of the initial treatment (n = 10) or led to a change (n = 28).
  
  
  CONCLUSIONS
  CTC did not alter management in the treatment of TDC infection. Because CTCs increase costs, their routine use should be abandoned in this population.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Cooper
authors.forename: Raphael M
authors.initials: RM
authors.lastname: Cohen
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berns
authors.forename: Zev Noah
authors.initials: ZN
authors.lastname: Kornfield
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D001431:Bacteriological Techniques / Q000191:economics; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D003362:Cost-Benefit Analysis; D020878:Device Removal; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents