Bacteremia associated with tunneled dialysis catheters: Comparison of two treatment strategies

Background. Tunneled dialysis catheters are often used for temporary vascul ar access in hemodialysis patients, but are complicated by frequent systemi c infections. The treatment of bacteremia associated with infected tunneled catheters requires both antibiotic therapy and catheter replacement. We co mpared the outcomes of two treatment strategies for catheter-associated bac teremia: exchange of the existing catheter with a new one over a guidewire versus catheter removal with delayed replacement. Methods. We retrospectively analyzed the outcomes of all cases of tunneled dialysis catheter-associated bacteremia during a two-year period. The infec tion-free survival lime of the subsequent catheter was evaluated in two gro ups of patients: group A (31 catheters), exchange of the existing infected catheter with a new catheter over a guidewire, and group B (38 catheters), removal of the infected catheter followed by delayed catheter replacement 3 to 10 days later. Patients in both. groups received three weeks of systemi c antibiotic therapy. Cox proportional hazard models were used to evaluate the factors predictive of infection-free survival time of the replacement c atheter. Results. On univariate proportional hazard regression analysis, the infecti on-free survival time of the replacement catheter was similar for groups A and B (P = 0.72), whereas the hazard of infection was significantly greater for patients with hypoalbuminemia (serum albumin < 3.5 g/dL), as compared with patients with a normal serum albumin (hazard ratio 2.81, 95% CI, 1.21, 6.53, P = 0.016). The infection-free survival time was not affected by pat ient age, sex, diabetic status, or type of organism (gram-positive coccus v s. gram-negative rod). Conclusions. The infection-free survival time associated with the subsequen t catheter is similar for the two treatment strategies. However, exchanging the catheter for a new one over a guidewire minimizes the number of separa te procedures required by the patient. Hypoalbuminemia is the major risk fa ctor for recurrent bacteremia in the replacement catheter.