Central venous catheter-related bacteremia in chronic hemodialysis patients: Epidemiology and evidence-based management

Ratnaja Katneni, S. Susan Hedayati

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients with end-stage renal disease treated with chronic hemodialysis. Risk factors include Staphylococcus aureus nasal colonization, longer duration of catheter use, previous bacteremia, older age, higher total intravenous iron dose, lower hemoglobin and serum albumin levels, diabetes mellitus and recent hospitalization. Symptoms that raise clinical suspicion of bacteremia in chronic hemodialysis patients are fevers and chills. When CRBSI is suspected, blood cultures should be obtained and empirical therapy with broad spectrum intravenous antibiotics initiated. The diagnosis of CRBSI is confirmed by isolation of the same microorganism from quantitative cultures of both the catheter and the peripheral blood of a patient that has clinical features of infection without any other apparent source. Gram-positive cocci, predominantly S. epidermidis and S. aureus, cause bacteremia in two-thirds of cases. Among the various approaches to management of CRBSI, removal and delayed replacement of the catheter, catheter exchange over a guidewire in selected patients, and the use of antimicrobial/citrate lock solutions have all been found to be promising for treatment and/or prevention; however, resolution of issues regarding selection, dose, duration and emergence of antibiotic-resistant organisms with chronic use of antibiotic lock solutions, as well as the safety of long-term use of trisodium citrate lock solutions, await further randomized, multicenter trials involving larger samples of hemodialysis patients.

Original languageEnglish (US)
Pages (from-to)256-266
Number of pages11
JournalNature Clinical Practice Nephrology
Volume3
Issue number5
DOIs
StatePublished - May 2007

Fingerprint

Central Venous Catheters
Bacteremia
Renal Dialysis
Epidemiology
Catheters
Infection
Anti-Bacterial Agents
Staphylococcus aureus
Gram-Positive Cocci
Chills
Nose
Serum Albumin
Citric Acid
Multicenter Studies
Chronic Kidney Failure
Diabetes Mellitus
Hemoglobins
Hospitalization
Fever
Iron

Keywords

  • Antibiotic lock solution
  • Catheter-related bacteremia
  • Central venous catheter
  • Hemodialysis

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{58690d3501d44339b82eb523cc03f2d1,
title = "Central venous catheter-related bacteremia in chronic hemodialysis patients: Epidemiology and evidence-based management",
abstract = "Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients with end-stage renal disease treated with chronic hemodialysis. Risk factors include Staphylococcus aureus nasal colonization, longer duration of catheter use, previous bacteremia, older age, higher total intravenous iron dose, lower hemoglobin and serum albumin levels, diabetes mellitus and recent hospitalization. Symptoms that raise clinical suspicion of bacteremia in chronic hemodialysis patients are fevers and chills. When CRBSI is suspected, blood cultures should be obtained and empirical therapy with broad spectrum intravenous antibiotics initiated. The diagnosis of CRBSI is confirmed by isolation of the same microorganism from quantitative cultures of both the catheter and the peripheral blood of a patient that has clinical features of infection without any other apparent source. Gram-positive cocci, predominantly S. epidermidis and S. aureus, cause bacteremia in two-thirds of cases. Among the various approaches to management of CRBSI, removal and delayed replacement of the catheter, catheter exchange over a guidewire in selected patients, and the use of antimicrobial/citrate lock solutions have all been found to be promising for treatment and/or prevention; however, resolution of issues regarding selection, dose, duration and emergence of antibiotic-resistant organisms with chronic use of antibiotic lock solutions, as well as the safety of long-term use of trisodium citrate lock solutions, await further randomized, multicenter trials involving larger samples of hemodialysis patients.",
keywords = "Antibiotic lock solution, Catheter-related bacteremia, Central venous catheter, Hemodialysis",
author = "Ratnaja Katneni and Hedayati, {S. Susan}",
year = "2007",
month = "5",
doi = "10.1038/ncpneph0447",
language = "English (US)",
volume = "3",
pages = "256--266",
journal = "Nature Reviews Nephrology",
issn = "1759-507X",
publisher = "Nature Publishing Group",
number = "5",

}

TY - JOUR

T1 - Central venous catheter-related bacteremia in chronic hemodialysis patients

T2 - Epidemiology and evidence-based management

AU - Katneni, Ratnaja

AU - Hedayati, S. Susan

PY - 2007/5

Y1 - 2007/5

N2 - Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients with end-stage renal disease treated with chronic hemodialysis. Risk factors include Staphylococcus aureus nasal colonization, longer duration of catheter use, previous bacteremia, older age, higher total intravenous iron dose, lower hemoglobin and serum albumin levels, diabetes mellitus and recent hospitalization. Symptoms that raise clinical suspicion of bacteremia in chronic hemodialysis patients are fevers and chills. When CRBSI is suspected, blood cultures should be obtained and empirical therapy with broad spectrum intravenous antibiotics initiated. The diagnosis of CRBSI is confirmed by isolation of the same microorganism from quantitative cultures of both the catheter and the peripheral blood of a patient that has clinical features of infection without any other apparent source. Gram-positive cocci, predominantly S. epidermidis and S. aureus, cause bacteremia in two-thirds of cases. Among the various approaches to management of CRBSI, removal and delayed replacement of the catheter, catheter exchange over a guidewire in selected patients, and the use of antimicrobial/citrate lock solutions have all been found to be promising for treatment and/or prevention; however, resolution of issues regarding selection, dose, duration and emergence of antibiotic-resistant organisms with chronic use of antibiotic lock solutions, as well as the safety of long-term use of trisodium citrate lock solutions, await further randomized, multicenter trials involving larger samples of hemodialysis patients.

AB - Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients with end-stage renal disease treated with chronic hemodialysis. Risk factors include Staphylococcus aureus nasal colonization, longer duration of catheter use, previous bacteremia, older age, higher total intravenous iron dose, lower hemoglobin and serum albumin levels, diabetes mellitus and recent hospitalization. Symptoms that raise clinical suspicion of bacteremia in chronic hemodialysis patients are fevers and chills. When CRBSI is suspected, blood cultures should be obtained and empirical therapy with broad spectrum intravenous antibiotics initiated. The diagnosis of CRBSI is confirmed by isolation of the same microorganism from quantitative cultures of both the catheter and the peripheral blood of a patient that has clinical features of infection without any other apparent source. Gram-positive cocci, predominantly S. epidermidis and S. aureus, cause bacteremia in two-thirds of cases. Among the various approaches to management of CRBSI, removal and delayed replacement of the catheter, catheter exchange over a guidewire in selected patients, and the use of antimicrobial/citrate lock solutions have all been found to be promising for treatment and/or prevention; however, resolution of issues regarding selection, dose, duration and emergence of antibiotic-resistant organisms with chronic use of antibiotic lock solutions, as well as the safety of long-term use of trisodium citrate lock solutions, await further randomized, multicenter trials involving larger samples of hemodialysis patients.

KW - Antibiotic lock solution

KW - Catheter-related bacteremia

KW - Central venous catheter

KW - Hemodialysis

UR - http://www.scopus.com/inward/record.url?scp=34247634515&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247634515&partnerID=8YFLogxK

U2 - 10.1038/ncpneph0447

DO - 10.1038/ncpneph0447

M3 - Article

C2 - 17457359

AN - SCOPUS:34247634515

VL - 3

SP - 256

EP - 266

JO - Nature Reviews Nephrology

JF - Nature Reviews Nephrology

SN - 1759-507X

IS - 5

ER -