title: Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review.
abstract: OBJECTIVE
  Patients with end-stage renal disease (ESRD) are at a high risk of bacterial infection. We reviewed publications on risk factors, prevention, and treatment paradigms, as well as outcomes associated with bacterial infection in end-stage kidney disease. We focused in particular on studies conducted in Canada where rates of haemodialysis catheter use are high.
  
  
  METHODS
  We included original research articles in English text identified from MEDLINE using search terms 'chronic kidney failure', 'renal dialysis', or 'chronic renal insufficiency', and 'bacterial infection'. We focused on articles with Canadian study populations and included comparisons to international standards and outcomes where possible.
  
  
  RESULTS
  Bacterial infections in this setting are most commonly due to Gram-positive skin flora, particularly Staphylococcus, with methicillin-resistant Staphylococcus aureus (MRSA) carrying a poorer prognosis. Interventions that may decrease mortality from sepsis include a collaborative care model that includes a nephrology team, an infectious disease specialist, and use of standardized care bundles that adhere to proven quality-of-care indicators. Decreased infectious mortality may be achieved by ensuring appropriate antibiotic selection and dosing as well as avoiding catheter salvage attempts. Reduction in bloodstream infection (BSI) incidence has been observed with the use of tPA catheter-locking solutions and the use of mupirocin or polysporin as a topical agent at the catheter exit site, as well as implementing standarized hygiene protocols during catheter use.
  
  
  CONCLUSIONS
  There has been a paucity of randomized controlled trials of prevention and treatment strategies for catheter-related BSIs in haemodialysis. Some past trials have been limited by lack of blinding and short duration of follow-up. Microbiological epidemiology, although well characterized, may vary by region and treatment centre.
  
  
  CONCLUSIONS
  With the high prevalence of catheter use in Canadian haemodialysis units, further studies on long-term treatment and preventative strategies for BSI are warranted.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Lata
authors.affiliation: Division of Nephrology, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9 Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Girard
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Parkins
authors.affiliation: Division of Nephrology, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9 Canada ; Division of Nephrology, Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 2T9 Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
keywords: Bacteremia; Bacterial infection; Complications; Haemodialysis; Prevention; Risk factors; Treatment