Management of cuffed tunned dialysis catheter infection.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:152A 1997
Infection of cuffed tunnelled dialysis catheters is a frequent cause of morbidity and hospitalization of dialysis patients. The DOQI clinical practice guidelines has addressed management of these infected catheters.
The authors of the present study present data on 99 patients with catheter-related bacteremia and report on outcome measures when these catheters were treated in one the following ways:
1. Forty-four bacteremic patients with minimal symptoms had their catheters replaced over a guidewire 24-48 hours after antibiotics had been initiated in the form of cefazolin in a dose of 2 grams followed by three weeks of antibiotics based on cultures.
2. Twenty-six patients with minimal symptoms and exit site inflammation had their catheters replaced over a guidewire and a new tunnel created with a new exit site.
3. Twenty-nine bacteremic patients with symptoms of sepsis had their catheters removed and a new catheter placed after resolution of symptoms.
The authors report no statistically significant difference in the measured clinical outcomes, those being culture negativity and symptom-free interval of 45 days after completion of antibiotic therapy. Similar rates of culture negativity were achieved in each of the three groups ranging between 50 and 69%. 2% patients died from the first group from causes unrelated to infection.
Comment: Management of these patients was broadly in line with the DOQI recommendations. The data is difficult to interpret because one of the outcome measures, i.e. clinical cure, was somewhat ambiguous. It is difficult to judge as to whether the recurrent symptoms were those of the original infection or of any infection at all. (Shahab Arfeen, M.D., Valparaiso, IN)
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ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Vascular Access: graft/fistula