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Hemodialysis catheter-related bacteremia in children: increasing antibiotic resistance and changing bacteriological
Carlos E Araya1, Robert S Fennell, Richard E Neiberger
1Division of Pediatric Nephrology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610-0296, USA.
Insights
Changes in bacterial organisms and antibiotic resistance patterns were observed in pediatric hemodialysis catheter-related bacteremia (HD-CRB) over a 10-year period. These shifts necessitated adjustments in empiric antibiotic therapy to ensure effective treatment for young dialysis patients.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Clinical Microbiology
Background:
- Catheter-related infections are a significant complication in patients undergoing hemodialysis.
- The effectiveness of antimicrobial treatment for hemodialysis catheter-related bacteremia (HD-CRB) is influenced by the causative microorganisms.
- Understanding temporal trends in bacterial pathogens and their antibiotic susceptibility is crucial for optimizing patient care.
Purpose of the Study:
- To analyze changes in the rate of positive blood cultures per catheter-day.
- To identify shifts in the spectrum of bacterial isolates causing HD-CRB.
- To evaluate alterations in antibiotic susceptibility patterns of these isolates over time in a pediatric dialysis unit.
Main Methods:
- Retrospective data collection of positive blood cultures from pediatric hemodialysis patients.
- Comparison of data from two distinct five-year periods: July 1990–July 1995 and July 2000–July 2005.
- Analysis of bacterial isolate types and their corresponding antibiotic susceptibility.
Main Results:
- Rates of HD-CRB remained stable between the two study periods.
- A shift in predominant organisms was observed, with a decrease in coagulase-positive staphylococci and an increase in Staphylococcus epidermidis and gram-positive bacilli.
- Significant decreases in gram-positive bacteria susceptibility to penicillins and cephalosporins were noted, while gram-negative bacteria susceptibility remained largely unchanged.
Conclusions:
- The types of organisms causing HD-CRB and their antibiotic sensitivity profiles have evolved over time.
- Empiric antibiotic regimens for HD-CRB require periodic reassessment based on local epidemiological data.
- The study led to a change in empiric antibiotic therapy to vancomycin plus an aminoglycoside for pediatric HD-CRB.
Background:
Catheter-related infections limit catheter survival. The success of antimicrobial therapy for the treatment of patients with hemodialysis catheter-related bacteremia (HD-CRB) depends on the infectious organisms. We determined whether the rate of positive blood culture results per tunneled catheter-days, the spectrum of bacterial isolates, and their antibiotic susceptibility changed over time in our pediatric dialysis unit.
Methods:
Data were collected retrospectively for all positive blood culture results from long-term hemodialysis patients in our pediatric unit from July 1990 to July 1995 (period A) and July 2000 to July 2005 (period B).
Results:
Rates of HD-CRB were similar between periods A and B (2.1 versus 2.2/1,000 catheter-days). In period A, 33% of isolates were coagulase-positive staphylococci, with Staphylococcus aureus accounting for 72% of these. In period B, the most common organism was Staphylococcus epidermidis (28%), whereas coagulase-positive staphylococci were identified in only 17%. There was a larger number of gram-positive bacilli in period B (20%) compared with period A (4%). A significant decrease in susceptibility to penicillins (40% to 5%; P = 0.007) and cephalosporins (58% to 21%; P = 0.04), but not aminoglycosides, was noted for gram-positive bacteria. There was no significant change in susceptibility of gram-negative bacteria to cephalosporins and aminoglycosides in either period.
Conclusion:
Both types of organism and antibiotic sensitivity patterns have changed over time. Based on these data, we changed our empiric antibiotic combination for HD-CRB to vancomycin plus an aminoglycoside.
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