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Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis.

Publication ,  Journal Article
Marr, KA; Sexton, DJ; Conlon, PJ; Corey, GR; Schwab, SJ; Kirkland, KB
Published in: Ann Intern Med
August 15, 1997

BACKGROUND: Dual-lumen cuffed catheters are used for vascular access in patients undergoing hemodialysis. The incidence and appropriate management of catheter-related bacteremia are unknown. OBJECTIVE: To determine the incidence and outcome of catheter-related bacteremia and to assess the efficacy of catheter salvage. DESIGN: Prospective, observational study. SETTING: University hospital inpatient service and four affiliated outpatient dialysis units. PATIENTS: 102 patients with end-stage renal disease who underwent hemodialysis with dual-lumen cuffed catheters between 1 April 1995 and 1 January 1996. MEASUREMENTS: Number of days that the catheter remained in situ, treatment (catheter removal or attempted salvage with antibiotic therapy), and outcome of bacteremia. Microbiological cultures were done to identify catheter-related bacteremia. RESULTS: 102 patients had a total of 16,081 catheter-days. Forty-one patients (40%) developed 62 episodes of bacteremia (3.9 episodes per 1000 catheter-days [95% CI, 3.0 to 4.9 episodes per 1000 catheter-days]). Twenty-four catheters (39%) were removed immediately, and 38 (61%) were left in place during treatment. Only 12 (32%) of the 38 catheters were salvaged successfully. Salvage was less likely to succeed in patients with gram-positive bacteremia than in patients with gram-negative bacteremia, but this difference was not statistically significant (P = 0.14). Nine of the 41 patients (22%) who developed bacteremia had the following complications: osteomyelitis (6 patients), septic arthritis (1 patient), infective endocarditis (4 patients), and death (2 patients). All complications followed an episode of gram-positive bacteremia, and none was associated with attempted catheter salvage. CONCLUSIONS: Bacteremia frequently occurs in patients undergoing hemodialysis with dual-lumen catheters. Antibiotic therapy without catheter removal is unlikely to eradicate catheter-related bacteremia in these patients, but attempted salvage may not increase the risk for complications.

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Published In

Ann Intern Med

DOI

ISSN

0003-4819

Publication Date

August 15, 1997

Volume

127

Issue

4

Start / End Page

275 / 280

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk
  • Renal Dialysis
  • Recurrence
  • Prospective Studies
  • Outpatients
  • Middle Aged
  • Male
  • Incidence
  • Humans
 

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Marr, K. A., Sexton, D. J., Conlon, P. J., Corey, G. R., Schwab, S. J., & Kirkland, K. B. (1997). Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med, 127(4), 275–280. https://doi.org/10.7326/0003-4819-127-4-199708150-00003
Marr, K. A., D. J. Sexton, P. J. Conlon, G. R. Corey, S. J. Schwab, and K. B. Kirkland. “Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis.Ann Intern Med 127, no. 4 (August 15, 1997): 275–80. https://doi.org/10.7326/0003-4819-127-4-199708150-00003.
Marr KA, Sexton DJ, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med. 1997 Aug 15;127(4):275–80.
Marr, K. A., et al. “Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis.Ann Intern Med, vol. 127, no. 4, Aug. 1997, pp. 275–80. Pubmed, doi:10.7326/0003-4819-127-4-199708150-00003.
Marr KA, Sexton DJ, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med. 1997 Aug 15;127(4):275–280.

Published In

Ann Intern Med

DOI

ISSN

0003-4819

Publication Date

August 15, 1997

Volume

127

Issue

4

Start / End Page

275 / 280

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk
  • Renal Dialysis
  • Recurrence
  • Prospective Studies
  • Outpatients
  • Middle Aged
  • Male
  • Incidence
  • Humans