Infection of Hemodialysis Catheters: Incidence and Mechanisms

Abstract

Fifty-three consecutive subclavian or jugular hemodialysis catheters inserted into 41 patients were prospectively studied over a period of 8 months in order to determine the incidence of infection and its mechanisms. The intravascular, intradermal and the Y catheter segments as well as both connections were cultured using a quantitative technique for the intraluminal surface. In addition, the intravascular and intradermal portions of the catheter were cultured using a semiquantitative technique for the external surface. Skin smears of the catheter entry site were also cultured, and blood cultures were similarly obtained if fewer developed. Twenty-nine of the 53 catheters (55%) were significantly colonized by one (19 cases) or more (10 cases) microorganisms. The source of the colonizing microorganisms was the skin in 17 cases (58 %), intraluminal in 5 (17 %), both routes in 5 (17 %) and others in 2 (6.8%). Staphylococcus epidermidis (22 cases) and Staphylococcus aureus (4 cases) were the bacteria most frequently isolated. Nine of the 53 catheterizations (17%) were complicated by catheter-related septicemia due to S. aureus in 4 cases, S. epidermidis in 3 cases, Streptococcus faecalis in 1 and Proteus vulgaris in 1. Catheter-related bacteremia contributed to a patient’s death in 1 case. Suppurative local infections of the catheter entry site developed in 3 cases, 2 of them with septicemia. We conclude that the rate of infection due to subclavian or jugular hemodialysis catheters is very high and that the skin is the most frequent origin of the microorganisms.

Stpahylococcus aureus biofilms on central venous haemodialysis catheters

“…In our study, positive tip semiquantitative cultures were obtained from 10 catheteres (40%), data consistent with findings of Almirall et al (1), 55%. The quantitative procedure showed that 4 catheters (16%) had 10 3 or more CFUs per milliliter, while cultures were negative in 18 (72%).…”

“…A number of investigators have used this procedure to quantify biofilms and determine the relationship between biofilm formation and bloodstream infection (1). However, this technique will not detect organisms on the inner lumen of the catheter and is unable to detect more than 1,000 CFU per tip (13).…”

Spondylodiscitis in patients under haemodyalisis

“…Bacteraemia is a common complication in haemodialysis patients resulting from contaminated vascular access devices [1,7,10,12,13]. The most frequent place for bacterial colonisation is the spine [23], frequently at the thoracolumbar junction.…”

“…Bacteraemia is also the first cause of morbidity and mortality in patients under haemodialysis [11]. Bacteraemia usually comes from the vascular contamination by intravenous catheters or punctures of the water-pipe [1,7,10,12,13], with Staphylococcus aureus as the most frequently isolated micro-organism. Very frequently, these patients are elderly, are immunocompromised, and suffer from some other concurrent diseases [9] which presage a high morbidity and mortality rate.…”

Comparison of a Silver-Coated Needleless Connector and a Standard Needleless Connector for the Prevention of Central Line-Associated Bloodstream Infections

“…Molecular typing of blood, skin, and catheter hub isolates suggests that most CLABSIs occurring early after line insertion originate from the skin (and are likely insertion-related events), whereas many CLABSIs occurring after the first 1-2 weeks of line placement are related to catheter hub contamination. [2][3][4][5][6][7][8] Most notable CLABSI prevention efforts to date have focused on optimizing insertion practices. 9 While these efforts have successfully decreased CLABSI rates, they have not eliminated preventable CLABSIs.…”