Hemodialysis vascular catheter-related bacteremia

Robert Sullivan, Vinny Samuel, Carol Le, Mohammad Khan, Irene Alexandraki, Bulent Cuhaci, Norris Stanley Nahman

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations

Abstract

Bacteremia in hemodialysis patients with cuffed tunneled catheters is a significant cause of morbidity and mortality. Native arteriovenous fistulas or vascular prostheses are preferred forms of vascular access, but their creation may not always be possible. Catheter-related bacteremia is due primarily to Gram-positive organisms, but Gram-negative infections are of increasing importance. Bacteremia in patients with catheters results from luminal or extraluminal contamination and may be perpetuated by infected fibrin sheaths associated with the catheter. Bacteremic patients require antibiotic therapy and catheter removal. Guide wire catheter exchange is appropriate in stable patients, but catheter removal and later reinsertion of a new catheter is indicated for tunnel infection or frank sepsis. Late diagnosis or ineffective therapy predisposes to vascular and extravascular infectious complications. Catheter-related bacteremia may be minimized with appropriate sterile technique at insertion, meticulous exit site care, and antibiotic lock solutions. Early recognition and treatment minimize morbidity and mortality, but the optimal solution remains the placement of permanent access.

Original languageEnglish (US)
Pages (from-to)458-465
Number of pages8
JournalAmerican Journal of the Medical Sciences
Volume334
Issue number6
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

Keywords

  • Bacteremia
  • Fibrin sheaths
  • Hemodialysis
  • Tunnel infection
  • Vascular catheters

ASJC Scopus subject areas

  • Medicine(all)

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