Document Detail

Clinical outcomes of dialysis catheter-related candidemia in hemodialysis patients.
MedLine Citation:
PMID:  19406968     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: Candidemia is a rare complication in catheter-dependent hemodialysis patients. As a result, there is uncertainty about its optimal medical management. The goal of this retrospective study was to compare the clinical outcomes of catheter-related candidemia managed with two different strategies: Guidewire exchange of the infected catheter versus removal with delayed replacement.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively queried a prospective, computerized vascular access database to identify 40 hemodialysis patients with catheter-related candidemia. All patients underwent treatment with antifungal medications for 2 wk, in conjunction with guidewire catheter exchange or catheter removal with delayed replacement. The primary outcomes were major complications, recurrent candidemia, and patient survival.
RESULTS: Candidemia represented approximately 2% of all cases of catheter-related bloodstream infections. Of the 40 patients with candidemia, 27 underwent guidewire catheter exchange and 13 had prompt catheter removal with delayed replacement. The two treatment groups were similar in demographic, clinical, and catheter characteristics. Only 1 (2.5%) patient developed a serious complication (endophthalmitis). Recurrence of candidemia within 3 mo was observed in 15% of each treatment group. Patient survival at 6 mo was similar in both groups.
CONCLUSIONS: Catheter-related candidemia is rare in hemodialysis patients and has a low complication rate. Catheter exchange over a guidewire in conjunction with antifungal therapy is an effective and safe treatment regimen.
Dmitri Sychev; Ivan D Maya; Michael Allon
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Publication Detail:
Type:  Journal Article     Date:  2009-04-30
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 Jun 
Date Detail:
Created Date:  2009-06-04     Completed Date:  2009-08-27     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:  1102-5     Citation Subset:  IM    
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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MeSH Terms
Antifungal Agents / therapeutic use
Candidiasis / drug therapy,  etiology*,  mortality
Catheters, Indwelling / adverse effects*,  microbiology*
Cross Infection / drug therapy,  etiology*,  mortality
Kidney Failure, Chronic / mortality,  therapy*
Middle Aged
Recurrence / prevention & control
Renal Dialysis*
Retrospective Studies
Treatment Outcome
Reg. No./Substance:
0/Antifungal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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