Bacterial colonization in hemodialysis temporary dual lumen catheters: a prospective study.
OBJECTIVE
The use of hemodialysis temporary dual-lumen catheters is often complicated by infections, which may be a significant cause of death among patients with end stage renal disease (ESRD). The aim of this study was to assess the incidence of bacteremia and bacterial colonization related to non-tunneled, non-cuffed, dual-lumen temporary catheters in patients with ESRD submitted to hemodialysis.


METHODS
This study included 29 patients with ESRD. After catheter implantation, patients were monitored throughout the period of catheter permanence by means of blood samples collected weekly from a peripheral vein. Bacteria were isolated and identified according to CLSI recommendations. When catheters were removed for any reason, their tips were evaluated microbiologically.


RESULTS
A total of 194 blood samples from the 29 patients implanted with 55 catheters were analyzed. Of these, 15.5% (30 samples) demonstrated bacterial growth, principally Staphylococcus epidermidis (64.5%). Twenty patients (68.9%) presented at least one positive blood culture during follow-up. The median time for catheter colonization was 18.5 days (95% CI: 16.8-30.3). Of the 55 catheters implanted, 28 (50.9%) showed bacterial colonization, corresponding to 23.4 episodes/1000 catheter/days and 9.2 episodes of bacteremia /1000 catheter/days. Fifteen of 28 catheter tips analyzed showed bacterial growth (53.5%). In 14 of these (93.3%), there was agreement between the isolates from the catheter tip and blood cultures. Of 24 episodes of positive blood cultures from 20 different patients in 17 episodes (70.8%), the patients showed no clinical signs or symptoms of bacteremia.


CONCLUSIONS
The high incidence of catheter colonization, the correlation between blood and catheter tip cultures, and the occurrence of frequent cases of asymptomatic bacteremia justify the proposal of routine peripheral blood collections to monitor patients undergoing hemodialysis with temporary dual-lumen catheters.
de Freitas
Lilyan Walkyria Caleiro
LW
Division of Infectious and Tropical Diseases - Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, São Paulo University, Brazil.
Neto
Miguel Moysés
MM
Nascimento
Margarida Maria Passeri
MM
Figueiredo
José Fernando de Castro
JF
D000328:Adult; D001166:Arteriovenous Shunt, Surgical; D016470:Bacteremia / Q000209:etiology; D001419:Bacteria / Q000254:growth & development*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D015169:Colony Count, Microbial; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D012307:Risk Factors