title: Prevention and management of hemodialysis catheter infections.
abstract: Hemodialysis (HD) catheters are associated with blood stream infections, and catheter use continues to be high among incident and prevalent patients on maintenance HD. Migration of micro-organism along the external surface of the catheter is probably the most common route of infection, followed by the endoluminal route of contamination. Almost all HD catheters have biofilm formation on their surfaces and this serves as a good reservoir for micro-organisms. These active but protected microorganisms have been implicated in local and systemic infections associated with HD catheters. Good personal hygiene, exit-site care with topical antibiotics and antibiotic lock solution in the dialysis catheter reduce the incidence of catheter infection. In selected subgroup of patients, HD catheter is promptly removed after the diagnosis of blood stream infection. However, catheter guidewire exchange is an acceptable alternate strategy in some patients. The most important goal should be to increase the rate of incident arteriovenous fistula use in the HD population.
authors.affiliation: Renal Section, Michael E DeBakey Veterans Affairs Medical Center & Baylor College of Medicine, 2002 Holcombe Blvd, 111-J, Houston, TX 77030, USA. ramanath@bcm.edu
authors.forename: Venkat
authors.initials: V
authors.lastname: Ramanathan
authors.forename: Rabih O
authors.initials: RO
authors.lastname: Darouiche
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000382:microbiology*; D004359:Drug Therapy, Combination; D006801:Humans; D006920:Hygiene / Q000592:standards; D006435:Renal Dialysis / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents