Highlights
- •We evaluated endoluminal surveillance cultures to prevent bacteremia in hemodialysis.
- •Our approach was useful in triaging patients at high risk of infection.
- •Antibiotic lock therapy was used only in patients with positive cultures.
- •Catheter-related bacteremia decreased from 1.65 to 0.27 episodes per 1,000 catheter days.
Background
To evaluate the use of surveillance cultures (SCs) to prevent catheter-related bloodstream
infections (CRBSIs) in asymptomatic hemodialysis (HD) patients.
Methods
In 2011-2012, we conducted a prospective study of HD patients with tunneled cuffed
central venous catheters (TCCs). Colonization of the catheter lumen was assessed every
15 days by inoculating ∼5 mL endoluminal blood into aerobic culture bottles. Individual
patients were triaged based on SC results: group 1 (negative); group 2 (coagulase-negative
Staphylococcus [CoNS] with time-to-positivity (TTP) >14 hours); group 3 (CoNS with TTP ≤14 hours);
and group 4 (any microorganism other than CoNS and any TTP).
Results
We studied 104 patients (129 TCCs). Median follow-up was 262.5 days (interquartile
range [IR], 135.0-365.0). A total of 1,734 SCs were collected (median, 18 per patient;
IR, 10.0-24.0), of which 1,634 (94.2%) were negative (group 1) and 100 (5.8%) were
positive (group 2: 79; group 3: 12, group 4: 9). In groups 2 and 3, 19 TCCs required
antibiotic lock therapy (ALT). In group 4, all patients received intravenous therapy
and ALT. Under this protocol, there were 0.27 episodes of CRBSI per 1,000 catheter
days compared with 1.65 (P < .001) prior to its implementation.
Conclusion
SCs based on easily accessible samples proved useful in triaging HD patients at a
high risk of infection.
Key Words
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References
- Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States.National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda [MD]2012
- El Catéter Venoso Central para Hemodiálisis y su Repercusión en la Morbimortalidad.Nefrologia. 2012; 32: 5-12
- Prevention of central line-associated bloodstream infections in hemodialysis patients.Infect Control Hosp Epidemiol. 2012; 33: 936-944
- Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement.J Infect Dis. 1993; 168: 400-407
- A prospective study of central venous hemodialysis catheters colonization and peripheral bacteriemia.Clin Nephrol. 1999; 51: 34-39
- Scanning and transmission electron microscopy of in situ bacterial colonization of intravenous and intraarterial catheters.J Clin Microbiol. 1984; 19: 687-693
- Catheter-related infections: diagnosis, treatment, and prevention.Clin Microbiol Newsl. 2003; 25: 113-118
- Management of the catheter in documented catheter-related coagulase-negative staphylococcal bacteremia: remove or retain?.Clin Infect Dis. 2009; 49: 1187-1194
- Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients.Am J Kidney Dis. 2010; 56: 566-577
- Prevention and management of catheter-related infection in hemodialysis patients.Kidney Int. 2011; 79: 587-598
- Prevention of catheter-related bloodstream infection in patients on hemodialysis.Nat Rev Nephrol. 2011; 7: 257-265
- Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings.Clin Infect Dis. 2010; 51: 335-341
- Preventing hemodialysis catheter-related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials.Nephrol Dial Transplant. 2008; 23: 1666-1672
- Anti-microbial locks increase the prevalence of Staphylococccus aureus and antibiotic-resistant Enterobacter: observational retrospective cohort study.Nephrol Dial Transplant. 2012; 27: 3575-3581
- Surveillance cultures of tunneled cuffed catheter exit sites in chronic hemodialysis patients are no benefit.Hemodial Int. 2006; 10: 365-370
- Intra-catheter leukocyte culture to monitor hemodialysis catheter colonization. A prospective study to prevent catheter-related bloodstream infections.Int J Artif Organs. 2008; 31: 820-826
- The relevance of catheter-drawn blood and heparin-lock fluid to diagnose infection in hematologic patients.Ann Hematol. 1992; 64: 28-34
- Superior antimicrobial activity of trisodium citrate over heparin for catheter locking.Nephrol Dial Transplant. 2002; 17: 2189-2195
- Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures.J Clin Microbiol. 2009; 47: 2950-2951
- Bacterial colonization of chronic hemodialysis catheters: evaluation with endoluminal brushes and heparin aspirate.J Vasc Access. 2002; 3: 38-42
- Catheter-drawn blood cultures: is withdrawing the heparin lock beneficial?.Pathology. 2004; 36: 170-173
- Endoluminal colonization as a risk factor for coagulase-negative staphylococcal catheter-related bloodstream infections in hemodialysis patients.Nephrol Dial Transplant. 2011; 26: 948-955
- A simple comorbiditiy scale predicts clinical outcomes and costs in dialysis patients.Am J Med. 2000; 108: 609-613
- Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America.Clin Infect Dis. 2009; 49: 1-45
- Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP).NDT Plus. 2010; 3: 234-246
- Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: a quasiexperimental cohort study.Am J Infect Control. 2013; 41: 520-526
- Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections.Nephrol Dial Transplant. 2009; 24: 3763-3774
- Interventions for preventing infectious complications in haemodialysis patients with central venous catheters.Cochrane Database Syst Rev. 2010; 1: CD006894https://doi.org/10.1002/14651858.CD006894.pub2
- Vital signs: central-line associated bloodstream infections-United States, 2001, 2008 and 2009.MMWR Morb Mortal Wkly Rep. 2011; 60: 243-248
- Reduction of biofilm formation with trisodium citrate in haemodialysis catheters: a randomized controlled trial.Nephrol Dial Transplant. 2010; 25: 1213-1217
- Morphometric and biological characterization of biofilm in tunneled hemodialysis catheters.Am J Kidney Dis. 2011; 57: 449-455
- Characteristics of biofilm on tunneled cuffed hemodialysis catheters in the presence and absence of clinical infection.Am J Kidney Dis. 2012; 60: 976-982
- Examination of tunnelled haemodialysis catheters using scanning electron microscopy.Clin Microbiol Infect. 2010; 16: 780-786
Article info
Publication history
Published online: September 20, 2014
Footnotes
Funding: This work was supported by Fundación Mutua Madrileña (grant no. FMM 2011/0064) and Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Spain (grant no. RD12/0015).
Conflict of interest: None to report.
Identification
Copyright
© 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
