Bacteremia associated with tunneled hemodialysis catheters: outcome after attempted salvage.
OBJECTIVE
Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood of treatment success.


METHODS
In a prospective cohort study, all cases of catheter-associated bacteremia that occurred in a large dialysis center were identified during a 12-mo period. Catheter salvage was attempted according to a standard protocol in all cases in which a favorable early response to antibiotic therapy was seen, and patients were followed for at least 6 mo. Bacteremias, catheter changes, and all major clinical events were recorded.


RESULTS
During a period covering 252,986 catheter days, 208 episodes were identified involving 133 patients, 74% of which were selected for attempted salvage. Salvage was successful in 66.1% of incident bacteremias with a very low complication risk (0.9%). Some bacteremias, however, recurred as late as 6 mo after the initial infection; salvage was less likely to be successful in treating recurrences.


CONCLUSIONS
Appropriately used catheter salvage can be successful in approximately two thirds of cases; however, recurrences continue to occur up to 6 mo later and are unlikely to be cured without catheter replacement.
Ashby
Damien R
DR
Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, United Kingdom. d.ashby@imperial.ac.uk
Power
Albert
A
Singh
Seema
S
Choi
Peter
P
Taube
David H
DH
Duncan
Neill D
ND
Cairns
Tom D
TD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000628:therapy*; D055499:Catheter-Related Infections / Q000382:microbiology / Q000628:therapy*; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome
J Am Soc Nephrol. 2005 May;16(5):1449-55
15788468
Nephrol Dial Transplant. 2004 May;19(5):1237-44
14993504
Nephrol Dial Transplant. 2008 Aug;23(8):2604-10
18332071
J Nephrol. 2006 May-Jun;19(3):265-79
16874685
Am J Kidney Dis. 2005 Sep;46(3):501-8
16129212
Kidney Int. 2002 Mar;61(3):1136-42
11849468
Nephrol Dial Transplant. 2006 Apr;21(4):1024-31
16449293
Nephrol Dial Transplant. 2008 Nov;23(11):3585-91
18552397
ASAIO J. 2005 Jan-Feb;51(1):77-81
15745139
Am J Kidney Dis. 2007 Jul;50(1):119-23
17591531
Am J Kidney Dis. 2007 Aug;50(2):289-95
17660030
Nephrol Dial Transplant. 2004 Nov;19(11):2816-22
15340094
Am J Kidney Dis. 2001 Jan;37(1 Suppl 1):S137-81
11229969
Ann Intern Med. 1997 Aug 15;127(4):275-80
9265426
Clin J Am Soc Nephrol. 2008 Nov;3(6):1726-32
18922993
Am J Med Sci. 2008 Oct;336(4):297-302
18854670
Ann Intern Med. 2008 Apr 15;148(8):596-605
18413621
Hemodial Int. 2007 Jan;11(1):72-5
17257359
Nephrol Dial Transplant. 1993;8(3):231-4
8385290
Artif Organs. 2005 May;29(5):399-405
15854216
Nephrol Dial Transplant. 2008 Oct;23(10):3219-26
18511606
Am J Kidney Dis. 1999 Dec;34(6):1114-24
10585322
Semin Dial. 2008 Nov-Dec;21(6):528-38
19000122