title: Microbiology of tunnelled catheter-related infections in a multi-ethnic South-east Asian patient population.
abstract: BACKGROUND
  Clinical practice guidelines recommend empiric antibiotic therapy for suspected tunnelled haemodialysis catheter-related infections (CRI), and the choice of antibiotics should be adjusted according to the local microbiological profile and antimicrobial sensitivities. We aim to describe the microbiology, antibiotic sensitivities, and clinical outcomes of CRI with tunnelled haemodialysis catheters in a multi-ethnic South-East Asian population.
  
  
  METHODS
  Using a prospective vascular access registry, we identified 99 patients who had catheters removed for suspected or confirmed CRI (50.5% male, mean age 56.9 years) from January 1, 2007, till May 2009. We retrospectively retrieved microbiology, mortality and echocardiography data from the hospital electronic databases.
  
  
  RESULTS
  There were 115 removal-unique cultures that yielded 75.7% Gram-positive and 24.3% Gram-negative isolates (15 removals were polymicrobial). Organisms isolated were methicillin-resistant Staphylococcus aureus (MRSA) 28.6%, methicillin-sensitive S. aureus 26.5%, coagulase-negative staphylococci 21.4%, Pseudomonas aeruginosa 10.2%, and others. Out of 8 patients who died, 7 had MRSA. Risk factors associated with mortality were Chinese race (p = 0.03), MRSA infection (p < 0.001), and older age (p < 0.001).
  
  
  CONCLUSIONS
  Gram-positive isolates accounted for most tunnelled CRI and MRSA was highly associated with death. In sick patients presenting with suspected CRI, the preferred empiric antibiotic regimen should include agents active against both MRSA and P. aeruginosa.
authors.affiliation: Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. mdctbw@nus.edu.sg
authors.forename: Boon Wee
authors.initials: BW
authors.lastname: Teo
authors.forename: Po Yi
authors.initials: PY
authors.lastname: Sau
authors.forename: Hui
authors.initials: H
authors.lastname: Xu
authors.forename: Valerie
authors.initials: V
authors.lastname: Ma
authors.forename: A
authors.initials: A
authors.lastname: Vathsala
authors.forename: Evan J C
authors.initials: EJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001210:Asia, Southeastern / Q000208:ethnology; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000208:ethnology* / Q000382:microbiology; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000208:ethnology*