Staphylococcus-Infected Tunneled Dialysis Catheters: Is Over-the-Wire Exchange an Appropriate Management Option?

Langer, Jessica M.; Cohen, Raphael M.; Berns, Jeffrey S.; Chittams, Jesse; Cooper, Emily T.; Trerotola, Scott O.

doi:10.1007/s00270-011-0180-4

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…The over-the-guidewire exchange method has been studied fairly thoroughly in cases where a tunneled catheter was exchanged for another tunneled one. [6][7][8][9][10][11][12][13] In HD patients, former dialysis catheter removal requires the reinsertion of a new catheter subsequently. With over-theguidewire method in tunneled catheter exchange, there is no delay in catheter reinsertion because it does not require time for hemostasis after the former catheter removal 6,7,9,12 and it has been proved that in the previous studies that the over-the-guidewire method does not increase the risk of infection and post-procedural bleeding after catheter insertion.…”

Section: Discussionmentioning

confidence: 99%

“…With over-the-guidewire method in tunneled catheter exchange, there is no delay in catheter reinsertion because it does not require time for hemostasis after the former catheter removal 6,7,9,12 and it has been proved that in the previous studies that the over-the-guidewire method does not increase the risk of infection and post-procedural bleeding after catheter insertion. 8,10,11,13 Based on these findings, the Infectious Diseases Society of America (IDSA) also comments positively about the tunneled catheter exchange over the guidewire in HD patients, although they recommended the de novo replacement of tunneled infusion catheters in non-dialysis patients. 14 However, although the exchange from a non-tunneled to a tunneled catheter is as common as the exchange from a tunnel catheter to another tunnel one in actual clinical fields, there are relatively few studies about exchanging a non-tunneled catheter for a tunneled one.…”

Section: Discussionmentioning

confidence: 99%

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Exchange over the guidewire from non-tunneled to tunneled hemodialysis catheters can be performed without patency loss

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Exchange over the guidewire from non-tunneled to tunneled hemodialysis catheters can be performed without patency loss

et al. 2018

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“…The results of this meta-analysis suggest that the use of guidewire exchange for S. aureus or GNR bacteremia may be a reasonable up-front treatment option. Langer et al 33 did not find a difference in cure rates when guidewire exchange was used to treat Amikacin 25 mg/ml, amphotericin B 2.5 mg/ml, cefazolin 5 mg/ml, ceftazidime 5 mg/ml, gentamicin 1 mg/ml, or vancomycin 1 mg/ml+heparin 2500 units/ml. Gentamicin could also be combined with either vancomycin or cefazolin (in addition to heparin).…”

Section: J Am Soc Nephrol 25: 2927-2941 2014mentioning

confidence: 97%

Systematic Review and Meta-Analysis on Management of Hemodialysis Catheter-Related Bacteremia

Aslam

Vaida

Ritter

et al. 2014

Journal of the American Society of Nephrology

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Hemodialysis catheter-related bacteremia is a common clinical problem with several management options. We performed a systematic review and meta-analysis to determine cure proportions with systemic antibiotics, antibiotic lock solution, and guidewire exchange. We searched databases and registries; conference proceedings from relevant medical societies; and article reference lists. Data regarding management approach, cure, follow-up, recurrence, complications, and microbiology were abstracted and pooled from 28 selected publications. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated from a mixed effects logistic regression model. In total, 1596 patients with tunneled hemodialysis catheter-related bacteremia were divided into groups on the basis of treatment with systemic antibiotics (n=697), antibiotic lock solution (n=546), or guidewire exchange (n=353). Antibiotic lock solution and guidewire exchange had similar cure proportions that were superior to systemic antibiotics alone (OR, 2.08; 95% CI, 1.25 to 3.45; P,0.01 for antibiotic lock solution; OR, 2.88; 95% CI, 1.82 to 4.55; P,0.001 for guidewire exchange versus systemic antibiotics). Cure proportions were highest for coagulase-negative staphylococci followed by gram-negative rods and Staphylococcus aureus. Among S. aureus infections, guidewire exchange led to a higher cure proportion than systemic antibiotics or antibiotic lock solution (OR, 3.33; 95% CI, 1.17 to 9.46; P=0.02; OR, 4.72; 95% CI, 1.79 to 12.46; P=0.002, respectively). Thus, results of this study suggest that tunneled hemodialysis catheter-related bacteremia should be treated with either guidewire exchange or antibiotic lock solution. Future studies should address prospectively whether one strategy is better than the other overall and for specific pathogens.

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“…[168][169][170][171] S. aureus CRBSI is one of the most difficult microorganisms to treat while maintaining a catheter in place due to its propensity to cause septic complications, treatment failure and relapses. 172,173 S. epidermidis CRBSI, however, has shown excellent results when treated conservatively by combining systemic and local antibiotics during the interdialytic period. 166 Alternatively, if retaining the catheter is not possible, catheter exchange over a guidewire has been shown to be safe.…”

Section: What Particular Aspects Should Be Considered In the Empiricamentioning

confidence: 99%

Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC)

Cháves

Garnacho-Montero

Pozo

et al. 2018

Enfermedades Infecciosas y Microbiología Clínica

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Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.

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Staphylococcus-Infected Tunneled Dialysis Catheters: Is Over-the-Wire Exchange an Appropriate Management Option?

Abstract: There is no significant difference in tunneled dialysis catheter survival between over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters and those infected with other organisms.

Cited by 11 publications

References 15 publications

Exchange over the guidewire from non-tunneled to tunneled hemodialysis catheters can be performed without patency loss

Exchange over the guidewire from non-tunneled to tunneled hemodialysis catheters can be performed without patency loss

Systematic Review and Meta-Analysis on Management of Hemodialysis Catheter-Related Bacteremia

Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC)

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