title: Staphylococcus-infected tunneled dialysis catheters: is over-the-wire exchange an appropriate management option?
abstract: OBJECTIVE
  Over-the-wire exchange of tunneled dialysis catheters is the standard of care per K/DOQI guidelines for treating catheter-related bacteremia. However, Gram-positive bacteremia, specifically with staphylococcus species, may compromise over-the-wire exchange due to certain biological properties. This study addressed the effectiveness of over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters compared with non-staphylococcus-infected tunneled dialysis catheters.
  
  
  METHODS
  Patients who received over-the-wire exchange of their tunneled dialysis catheter due to documented or suspected bacteremia were identified from a QA database. Study patients (n = 61) had positive cultures for Staphylococcus aureus, Staphylococcus epidermidis, or coagulase-negative staphylococcus not otherwise specified. Control patients (n = 35) received over-the-wire exchange of their tunneled dialysis catheter due to infection with any organism besides staphylococcus. Overall catheter survival and catheter survival among staphylococcal species were assessed.
  
  
  RESULTS
  There was no difference in tunneled dialysis catheter survival between study and control groups (P = 0.46). Median survival time was 96 days for study catheters and 51 days for controls; survival curves were closely superimposed. There also was no difference among the three staphylococcal groups in terms of catheter survival (P = 0.31). The median time until catheter removal was 143 days for SE, 67 days for CNS, and 88 days for SA-infected catheters.
  
  
  CONCLUSIONS
  There is no significant difference in tunneled dialysis catheter survival between over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters and those infected with other organisms.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Langer
authors.forename: Raphael M
authors.initials: RM
authors.lastname: Cohen
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berns
authors.forename: Jesse
authors.initials: J
authors.lastname: Chittams
authors.forename: Emily T
authors.initials: ET
authors.lastname: Cooper
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology / Q000628:therapy*; D016022:Case-Control Studies; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D006435:Renal Dialysis / Q000295:instrumentation*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology / Q000628:therapy*; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents