Hemodialysis Central Venous Catheter-Related Bacteremia: Time to Onset
Abstract:Bacteremia (B) is a well-known complication of an indwelling central venous catheter (CVC). Although prophylactic measures such as topical and catheter lock antibiotics have been demonstrated to decrease the risk of B in hemodialysis (HD) in patients with a CVC, there are concerns about the development of resistance to these agents when used for long periods of time. Objective:
We wondered if we could limit the use of these agents by identifying the period when B was most common after CVC placement. Method:
We prospectively noted all patients with a CVC who developed B in any of our 3 units in CT, U.S.A.; 62 episodes of B occurred between 1/1/03 and 9/18/03. 35% of all of the HD patients had a CVC for access during the study period. Results:
Staphylococcus aureus accounted for 22 (35.5%) episodes; Gram-negative organisms for 21 (33.8%) and other staphylococcal species for 14 (22.6%). The other 3 episodes were other Gram-positive organisms and 6 patients developed B with more than 1 organism. 3 (4.8%) patients expired while being treated for the B. The average time to onset of B was 96 ± 98 CVC days with a range of 1–365 days. There was no difference in time to onset based on organism. 43.5% of the episodes of B occurred less than 60 days after the CVC was inserted, but 27.4% occurred greater than 100 days after CVC insertion. Conclusion:
The time to onset of CVC-related B was variable among the patients developing B in this study. Preventative strategies aimed at reducing the risk of B in patients with a CVC must be used for the life of the CVC.
Document Type: Research Article
Affiliations: Renal Research Institute, New Haven, CT, U.S.A.
Publication date: January 1, 2004