CATHETER-RELATED BACTEREMIA AND OUTCOME OF ATTEMPTED CATHETER SALVAGEIN PATIENTS UNDERGOING HEMODIALYSIS

Background: Dual-lumen cuffed catheters are used for vascular access i n patients undergoing hemodialysis. The incidence and appropriate mana gement of catheter-related bacteremia are unknown, Objective: To deter mine the incidence and outcome of catheter-related bacteremia and to a ssess the efficacy of catheter salvage. Design: Prospective, observati onal study. Setting: University hospital inpatient service and four af filiated outpatient dialysis units. Patients: 102 patients with end-st age renal disease who underwent hemodialysis with dual-lumen cuffed ca theters between 1 April 1995 and 1 January 1996, Measurements: Number of days that the catheter remained in situ, treatment (catheter remova l or attempted salvage with antibiotic therapy), and outcome of bacter emia. Microbiological cultures were done to identify catheter-related bacteremia. Results: 102 patients had a total of 16 081 catheter-days. Forty-one patients (40%) developed 62 episodes of bacteremia (3.9 epi sodes per 1000 catheter-days [95% CI, 3.0 to 4.9 episodes per 1000 cat heter-days]). Twenty-four catheters (39%) were removed immediately, an d 38 (61%) were left in place during treatment. Only 12 (32%) of the 3 8 catheters were salvaged successfully. Salvage was less likely to suc ceed in patients with gram-positive bacteremia than in patients with g ram-negative bacteremia, but this difference was not statistically sig nificant (P = 0.14). Nine of the 41 patients (22%) who developed bacte remia had the following complications: osteomyelitis (6 patients), sep tic arthritis (1 patient), infective endocarditis (4 patients), and de ath (2 patients). All complications followed an episode of gram-positi ve bacteremia, and none was associated with attempted catheter salvage , Conclusions: Bacteremia frequently occurs in patients undergoing hem odialysis with dual-lumen catheters. Antibiotic therapy without cathet er removal is unlikely to eradicate catheter-related bacteremia in the se patients, but attempted salvage may not increase the risk for compl ications.