title: Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment.
abstract: OBJECTIVE
  Infectious complications associated with central venous catheters (CVCs) are a major source of morbidity and mortality among hemodialysis (HD) patients. This review aims to discuss prevention, diagnosis criteria and management of CVC-related infections in HD patients.
  
  
  METHODS
  We searched Medline for articles published in the last 10 years, with the keywords "catheter," "hemodialysis," "infection," "treatment," "diagnosis," "prophylaxis" and "adults." Only English language articles were reviewed. We reviewed prophylaxis and surveillance protocols, diagnosis criteria, including new molecular tools, and the management of catheter-related infections, including antibiotic regimen, empiric and according to causal agents, lock therapy, catheter salvage or removal choice and treatment of complications.
  
  
  RESULTS
  To prevent infectious complications, first of all we need to avoid using catheters. If we need CVC, adoption of prophylaxis and surveillance protocols, and antibiotic ointment at the exit site reduce infectious complications. The diagnosis of CVC-related infections should be made with drainage and/or blood cultures. Empiric systemic antibiotics should cover Gram-positive and -negative microorganisms, and final regimen should be based on culture results. In selected cases, salvage of site, by CVC exchange over wire, or salvage of catheter, using antibiotic lock, under the cover of systemic antibiotics, could be attempted.
  
  
  CONCLUSIONS
  The best approach to prevent CVC-related infection would be to avoid the use of CVC. However, in patients for whom it is impossible, the adoption of adequate prophylaxis protocols, early diagnosis and effective treatment of infectious complications are essential to improve outcomes.
authors.affiliation: Dialysis and Transplantation Center, São Francisco de Paula University Hospital, Catholic University of Pelotas, Pelotas - Brazil.
authors.forename: Maristela
authors.initials: M
authors.lastname: Böhlke
authors.forename: Gustavo
authors.initials: G
authors.lastname: Uliano
authors.forename: Franklin C
authors.initials: FC
authors.lastname: Barcellos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D020878:Device Removal; D004867:Equipment Design; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents