title: Predictors of failure of catheter salvage in incident hemodialysis patients.
abstract: OBJECTIVE
  Catheter-related bloodstream infection is a frequent complication for patients who use catheter as dialysis access. This study was performed to identify the risk factors for failed catheter salvage.
  
  
  METHODS
  We enrolled patients who received non-tunneled catheters as initial vascular access during a two-year period. Catheter salvage was attempted in all symptomatically mild patients. Patients were prospectively followed for 8 weeks starting from the day of infection. Risk factors for salvage failure were explored.
  
  
  RESULTS
  A total of 77 bacteremia episodes occurred in 69 patient, with an infection rate of 1.61 per 1,000 catheter days. Salvage was successful in 73.4% of all episodes. We found that higher ferritin levels (greater vs. lower than 500 mg/l, (odds ratio (OR) 6.388, 95% confidence interval (CI) 2.073, 19.686), higher phosphate levels (greater vs. lower than 5.5 mg/dl, OR 4.084, 95% CI 1.391, 11.978) and shorter time intervals between catheterization and infection (within vs. beyond 3 weeks, OR 4.190, 95% CI 1.279, 13.725) predicted salvage failure.
  
  
  CONCLUSIONS
  Catheter salvage can be a reasonable initial strategy for symptomatically mild patients. We propose salvaging aggressively and waiting watchfully; however, clinical judgment is prior to any specific management protocol.
authors: Department of Nephrology, Chengdu Military General Hospital, Chengdu, China.
authors: Zhou
authors: Z
authors: Zhou
authors: Dongyang
authors: D
authors: Guo
authors: Fan
authors: F
authors: Zhang
authors: Tao
authors: T
authors: Wang
authors: Guangming
authors: G
authors: Zhang
authors: Bin
authors: B
authors: Zhou
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D016009:Chi-Square Distribution; D020878:Device Removal; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D016879:Salvage Therapy; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D057832:Watchful Waiting
chemical_list: D000900:Anti-Bacterial Agents