title: Bacteremia associated with tunneled hemodialysis catheters: outcome after attempted salvage.
abstract: 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.
authors.affiliation: Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, United Kingdom. d.ashby@imperial.ac.uk
authors.forename: Damien R
authors.initials: DR
authors.lastname: Ashby
authors.forename: Albert
authors.initials: A
authors.lastname: Power
authors.forename: Seema
authors.initials: S
authors.lastname: Singh
authors.forename: Peter
authors.initials: P
authors.lastname: Choi
authors.forename: David H
authors.initials: DH
authors.lastname: Taube
authors.forename: Neill D
authors.initials: ND
authors.lastname: Duncan
authors.forename: Tom D
authors.initials: TD
authors.lastname: Cairns
mesh_terms: 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
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