Management of the Hemodialysis Patient with Catheter-Related Bloodstream Infection

Farrington, Crystal A.; Allon, Michael

doi:10.2215/cjn.13171118

Cited by 27 publications

(36 citation statements)

References 10 publications

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“…Catheter-related bloodstream infections, exit-site infections, and tunnel infections are frequent complications related to HD-CVC. Catheter-related bloodstream infection is the most serious complication in patients on hemodialysis with prolonged CVC dependence, and it can lead to a fatal outcome [ 9 ]. No specific clinical parameter can predict tunneled hemodialysis CVC-related infection [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections

et al. 2020

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Background In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates. Methods An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019. Results In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81–1.68)/1000 days [2.07 (95% CI 1.12–3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51–1.24)/1000 days [1.04 (95% CI 0.41–2.15)/1000 days in the Feb–May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01–0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15–1.6)/1000 days. Conclusions The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002–0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004–1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections

et al. 2020

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“…Finding safe opportunities to place permanent vascular accesses could stave off lifethreatening bloodstream infections and thromboembolic complications associated with long-term dialysis catheter use. [34][35][36] Doing so may not be easy. Globally, the 12-week cancellation rate for elective, nononcologic surgeries is 82%, leading to a backlog of cases projected to take a median of 45 weeks to clear.…”

Section: Dialysis Access Proceduresmentioning

confidence: 99%

Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak

Truong

Dittmar

Ghaffari

et al. 2020

Advances in Chronic Kidney Disease

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The coronavirus (coronavirus disease-2019) pandemic has changed care delivery for patients with end-stage kidney disease. We explore the US healthcare system as it pertains to dialysis care, including existing policies, modifications implemented in response to the coronavirus disease-2019 crisis, and possible next steps for policy makers and nephrologists. This includes policies related to resource management, use of telemedicine, prioritization of dialysis access procedures, expansion of home dialysis modalities, administrative duties, and quality assessment. The government has already established policies that have instated some flexibilities to help providers focus their response to the crisis. However, future policy during and after the coronavirus disease-2019 pandemic can bolster our ability to optimize care for patients with end-stage kidney disease. Key themes in this perspective are the importance of policy flexibility, clear strategies for emergency preparedness, and robust health systems that maximize accessibility and patient autonomy.

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“…It is expected that Gram-positive bacteria growth, especially including skin flora microorganisms, will be seen in bloodstream infections caused by hemodialysis catheter. Accordingly, bacteria in the skin flora often colonize the catheter, and pass to the bloodstream [2][3][4][5]. Quittnat Pelletier et al [9] reported that Gram-positive bacteria were grown in 74.1% of 178 hemodialysis catheter-related bloodstream infection cases, and that the most common bacteria were S. aureus (34.5%), Serratia marsescens (17.2%) and coagulase-negative staphylococci (11.2%).…”

Section: Discussionmentioning

confidence: 99%

“…The most common complications are central catheter-related bloodstream infections, which is a healthcare-related infection, and these bacteraemias may progress to infective endocarditis and serious infections that may eventually result in death. [4][5][6][7][8]. Gram-positive bacteria are the most common factors in central catheter-related bloodstream infections in hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Blood circulation infections and empirical treatment approach in hemodialysis patients

2020

Ann Clin Anal Med

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Aim: Catheter infection is an important complication of hemodialysis that may cause sepsis and death. In our study, it was aimed to analyze the catheter and blood culture results of patients who underwent hemodialysis due to chronic kidney failure. Materials and Methods: In a special dialysis center providing ambulatory hemodialysis service, 1202 patients with chronic renal failure who underwent hemodialysis between January 2017 and June 2019 were included in the study. At least one hemodialysis catheter lumen and simultaneous peripheral blood culture were taken from patients with the suspicion of catheter-related bloodstream infection. In 95 of the patients, 115 catheter-related bloodstream infections attacks were detected. The results were evaluated retrospectively. Results: Gram-positive and Gram-negative bacteria were grown in 66.1% and 33.9%, respectively. The most frequent microorganisms were coagulasenegative staphylococci (42.7%), Staphylococcus aureus (14.5%), and Enterobacter cloacae (13.7%). A total of 38.9% of the S. aureus isolates were resistant to methicillin. All of the E. cloacae isolates were susceptible to high levels of aminoglycosis, carbapenems, colistin, and tigecycline. The detection rate of polymicrobial bacteraemia was 8.6%. Discussion: Our study was one of the rare studies investigating catheter-induced bacteraemia cases and a possible Gram-negative bacterial outbreak in hemodialysis patients. We consider that the data of our study about the microorganisms in hemodialysis catheter-related bacteraemia cases will be informative to clinicians and researchers, and it will be remarkable for taking measures to protect hemodialysis patients against possible outbreaks.

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Management of the Hemodialysis Patient with Catheter-Related Bloodstream Infection

Cited by 27 publications

References 10 publications

Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections

Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections

Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak

Blood circulation infections and empirical treatment approach in hemodialysis patients

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