Management of hemodialysis catheter-related bacteremia - a 10-year experience

Abstract

Between January 1986 and December 1995, 18 episodes of bacteremia occurred in our pediatric patients undergoing chronic hemodialysis on an outpatient basis. Seven episodes were caused by coagulase-negative Staphylococcus, 6 by Staphylococcus aureus, 2 by Mycobacterium, and 1 each by Pseudomonas, Xanthomonas, and Enterococcus. In 6 cases, the catheter was retained with antimicrobial therapy alone, whereas 12 cases required removal of the catheter after some period of time. The subset of cases in which catheter removal was necessary included 2 cases of Mycobacterium fortuitum complex and 5 cases of Staphylococcus aureus. We found that Staphylococcus aureus bacteremia may be cleared with antibiotic therapy alone in a minority of cases (17%). In the 6 cases in which catheters were retained and infections cleared, the maximum length of time to sterilization of blood with appropriate antibiotics was 48 h.

Low Infection Rates and Prolonged Survival Times of Hemodialysis Catheters in Infants and Children

“…This is in sharp contrast to recent studies (7)(8)(9)11,15) showing that infection is the leading cause for CVC removal in children on long-term HD, with up to 42% of CVCs lost because of infection (Table 1). Our finding of a very low rate of infection-related catheter loss further shows the efficacy of our catheter management protocols.…”

“…Nevertheless, data on CVC infection rates and survival times in children on HD therapy are scarce. Several studies (4,(7)(8)(9)(10)(11)(12) (Table 1) have reported a rate of bacterial infection in CVCs used for HD in children with ESRD in the range of 1.5 to 4.8 episodes/1000 catheter days. Reported CVC survival times have varied between 84 and 290 days (4,(7)(8)(9)(10).…”

Catheter-related infections in children treated with hemodialysis

“…Rates of CRBSI in patients in pediatric intensive care units are higher than those in patients in adult intensive care units [8]. Table 1 shows the etiology of CVC-related infections in three studies of children treated with HD [13,15,16]. Coagulase-negative staphylococci and Staphylococcus aureus were the most frequent bacterial isolates, followed by enterococci, gram-negative pathogens, mycobacteria, and Candida spp.…”

“…Coagulase-negative staphylococci and Staphylococcus aureus were the most frequent bacterial isolates, followed by enterococci, gram-negative pathogens, mycobacteria, and Candida spp. [13,15,16]. Interestingly, Hymes et al [16] reported an outbreak of bacteremia secondary to Enterococcus fecalis in a pediatric hemodialysis unit in which no common source of Enterococcus could be identified by cultures or serotyping.…”

“…The documented overall CRBSI rate reported in the majority of pediatric and adult studies was 1.2-1.6 episodes/ 1,000 catheter days [15,16,17,18,19,20,21]. Rates of CRBSI in patients in pediatric intensive care units are higher than those in patients in adult intensive care units [8].…”