title: Usefulness of endoluminal catheter colonization surveillance cultures to reduce catheter-related bloodstream infections in hemodialysis.
abstract: BACKGROUND
  To evaluate the use of surveillance cultures (SCs) to prevent catheter-related bloodstream infections (CRBSIs) in asymptomatic hemodialysis (HD) patients.
  
  
  METHODS
  In 2011-2012, we conducted a prospective study of HD patients with tunneled cuffed central venous catheters (TCCs). Colonization of the catheter lumen was assessed every 15 days by inoculating ~5 mL endoluminal blood into aerobic culture bottles. Individual patients were triaged based on SC results: group 1 (negative); group 2 (coagulase-negative Staphylococcus [CoNS] with time-to-positivity (TTP) >14 hours); group 3 (CoNS with TTP ≤14 hours); and group 4 (any microorganism other than CoNS and any TTP).
  
  
  RESULTS
  We studied 104 patients (129 TCCs). Median follow-up was 262.5 days (interquartile range [IR], 135.0-365.0). A total of 1,734 SCs were collected (median, 18 per patient; IR, 10.0-24.0), of which 1,634 (94.2%) were negative (group 1) and 100 (5.8%) were positive (group 2: 79; group 3: 12, group 4: 9). In groups 2 and 3, 19 TCCs required antibiotic lock therapy (ALT). In group 4, all patients received intravenous therapy and ALT. Under this protocol, there were 0.27 episodes of CRBSI per 1,000 catheter days compared with 1.65 (P < .001) prior to its implementation.
  
  
  CONCLUSIONS
  SCs based on easily accessible samples proved useful in triaging HD patients at a high risk of infection.
authors.affiliation: Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Brañas
authors.affiliation: Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Morales
authors.affiliation: Centro de Diálisis San Luciano, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ríos
authors.affiliation: Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Sanz
authors.affiliation: Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gutiérrez
authors.affiliation: Centro de Diálisis San Luciano, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Quintanilla
authors.affiliation: Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Orellana
authors.affiliation: Centro de Diálisis San Luciano, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sánchez
authors.affiliation: Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Rodríguez-Aranda
authors.affiliation: Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: fernando.chaves@salud.madrid.org.
authors.forename: Fernando
authors.initials: F
authors.lastname: Chaves
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000382:microbiology*; D062665:Epidemiological Monitoring; D006801:Humans; D007362:Intensive Care Units; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial lock therapy; Catheter colonization; Catheter-related bloodstream infection; Hemodialysis