Document Detail


Bacteremia associated with tunneled hemodialysis catheters: outcome after attempted salvage.
MedLine Citation:
PMID:  19679668     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood of treatment success.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a prospective cohort study, all cases of catheter-associated bacteremia that occurred in a large dialysis center were identified during a 12-mo period. Catheter salvage was attempted according to a standard protocol in all cases in which a favorable early response to antibiotic therapy was seen, and patients were followed for at least 6 mo. Bacteremias, catheter changes, and all major clinical events were recorded.
RESULTS: During a period covering 252,986 catheter days, 208 episodes were identified involving 133 patients, 74% of which were selected for attempted salvage. Salvage was successful in 66.1% of incident bacteremias with a very low complication risk (0.9%). Some bacteremias, however, recurred as late as 6 mo after the initial infection; salvage was less likely to be successful in treating recurrences.
CONCLUSIONS: Appropriately used catheter salvage can be successful in approximately two thirds of cases; however, recurrences continue to occur up to 6 mo later and are unlikely to be cured without catheter replacement.
Authors:
Damien R Ashby; Albert Power; Seema Singh; Peter Choi; David H Taube; Neill D Duncan; Tom D Cairns
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-08-13
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  4     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2010-01-07     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1601-5     Citation Subset:  IM    
Affiliation:
Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, United Kingdom. d.ashby@imperial.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bacteremia / microbiology,  therapy*
Catheter-Related Infections / microbiology,  therapy*
Cohort Studies
Humans
Middle Aged
Prospective Studies
Recurrence
Renal Dialysis / adverse effects*
Treatment Outcome
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