title: Tunneled hemodialysis catheter-related bloodstream infections: a prospective multicenter cohort study from Spain.
abstract: OBJECTIVE
  Catheter-related bloodstream infections (CRBSI) are common among patients undergoing long-term hemodialysis (HD) worldwide. The aim of this study was look into the incidence, epidemiology, and risk factors for CRBSI in four medical centers and Spanish dialysis facilities following a common protocol for insertion and management of tunneled hemodialysis catheters (THCs).
  
  
  METHODS
  Prospective study including all THCs inserted from September-04 to October-05. Follow-up was from THC insertion to its withdrawal, onset of CRBSI or end of study. Data of all THCs, CRBSI episodes, and catheter complications were collected. A descriptive analysis of CRBSI incidence and etiology and multivariate Cox regression to identify risk factors for CRBSI was performed.
  
  
  RESULTS
  A total of 130 THCs in 123 patients were inserted. There were 34 879 catheter-days. Twelve CRBSI in 11 patients with a CRBSI rate of 0.34/1000 catheter-days were recorded. CRBSI was caused by gram-positive coccus in 91.7% of the cases. Vascular cause of renal disease (HR 25.5 CI95% 5.5-117.2), and a previous THC (HR 5.1 CI95% 1.3-19.1) were identified as risk factors for CRBSI. CRBSI were satisfactorily resolved in 83.3% of the cases. Overall mortality was 14.6% (18/123), in two cases (2/11) death occurred within 30 days after CRBSI onset.
  
  
  CONCLUSIONS
  Although some factors, such as vascular cause of renal disease and previous THC medical history, have been related to the onset of tunneled catheter-related bloodstream infections, the incidence of these bacteremia, mainly produced by gram-positive coccus, is low among hemodialysis patients and the mortality rate is not high.
authors.affiliation: Department of Infectious Diseases, Clinical Microbiology and Preventive Medicine, University Hospital Virgen del Rocío, Sevilla, Spain. almudena.martin.pena@gmail.com
authors.forename: Almudena
authors.initials: A
authors.lastname: Martín-Peña
authors.forename: Rafael
authors.initials: R
authors.lastname: Luque Márquez
authors.forename: M José Marco
authors.initials: MJ
authors.lastname: Guerrero
authors.forename: Nuria
authors.initials: N
authors.lastname: Espinosa
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Blanco
authors.forename: José
authors.initials: J
authors.lastname: Ibeas
authors.forename: Ma José
authors.initials: MJ
authors.lastname: Ríos-Villegas
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cisneros
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult