ORIGINAL ARTICLE
Central Venous Catheter-Related Bacteremia
in Chronic Hemodialysis Patients: Saudi Single Center
Experience
More details
Hide details
1
Prince Salman center for kidney disease, Riyadh, Kingdom of Saudi Arabia
2
Mansoura
Urology and Nephrology Center, Mansoura University, Egypt
Publication date: 2013-10-09
Corresponding author
Khalid Al Saran
Prince Salman center for kidney disease, Riyadh, Kingdom of Saudi Arabia
Eur J Gen Med 2013;10(4):208-213
KEYWORDS
ABSTRACT
Central vein catheters (CVC) are an important means of delivering hemodialysis (HD) to patients who require immediate initiation of dialysis
but are without a mature functioning arterio-venous fistula or graft. The frequency of catheter-related bacteremia (CRB) reported
in several large series ranged between 2.5 and 5.5 cases/1,000catheter-days. The aim of the study was to evaluate the incidence, spectrum
of infecting organisms, risk factors, and optimal treatment for catheter-related bacteremia.This retrospective study of clinical records
was conducted between January 2005 and January 2009 where all episodes of catheter related bacteremia in the preceding 4 years were a
subject of our study. Data recorded for each patient included the number of catheter-days, episodes of suspected bacteremia, blood culture
results, method of treatment, complications, and outcomes. All patients with CRB were treated with a 21-day course of intravenous
antibiotics, with surveillance cultures obtained 1 week after completing the course of antibiotics. The CVC was removed if the patient
had uncontrolled sepsis or if other vascular access was ready for use. Once the infection was controlled, catheter salvage was considered
successful, leaving the original CVC in place. 93 chronic hemodialysis (HD) patients, 42 male (45.25%) and51 female (54.8%) were included,
with median age51.67 years. During this study, there were 37087catheter-days, with 52 episodes of CRB, or 1.4 episodes/1,000 catheterdays.
Thirty- five infections (67.3%) were caused by gram-positive cocci only, including Staphylococcus aureus, Staphylococcus simulans,
and Staphylococcus haemolyticus. Seventeen infections (32.7%) were caused by gram-negative rods only, including a wide variety of enteric
organisms. Five CVCs were removed because of severe uncontrolled sepsis, of the remaining 47 cases; attempted CVC salvage was
successful in (90.3%). The only important complication of CRB was endocarditis, occurring in 1 of 52 episodes (1.9%). We conclude that in
our study, CRB is relatively near the lower limit of normal range with low incidence of complication and frequently involves gram-positive
bacteria. CVC salvage is significantly improved when CVC was treated by antibiotic based on blood culture results.