Clinical management of dialysis catheter-related bacteremia with concurrent exit-site infection

Area of Science:

• Nephrology
• Infectious Diseases
• Vascular Access

Background:

• Catheter-related bacteremia (CRB) is a common complication in patients requiring dialysis.
• Systemic antibiotics and antibiotic locks are often used to salvage infected dialysis catheters.
• The efficacy of catheter salvage for CRB with concurrent exit-site infections is not well-established.

Purpose of the Study:

• To investigate the characteristics and outcomes of dialysis catheter-related bacteremia (CRB) associated with concurrent exit-site infections.
• To determine the optimal management strategy for CRB with exit-site infections based on the causative pathogen.

Main Methods:

• Retrospective analysis of a prospective, computerized vascular access database.
• Identification of 1436 episodes of CRB, with a focus on 64 cases exhibiting concurrent exit-site infections.
• Comparison of infection frequency, complication rates, and catheter survival between different bacterial pathogens.

Main Results:

• Concurrent exit-site infections were most frequent with Staphylococcus species (9.6% S. epidermidis, 6.1% S. aureus) compared to Gram-negative rods (0.7%).
• Patients with S. aureus CRB experienced significantly more serious complications (sepsis, endocarditis) and shorter catheter survival (14 days) compared to S. epidermidis (30 days).
• No serious complications were observed in S. epidermidis infections, suggesting a better prognosis.

Conclusions:

• Concurrent exit-site infection in CRB is predominantly associated with Staphylococcus species.
• Catheter salvage with systemic antibiotics and antibiotic locks is a reasonable approach for S. epidermidis CRB with exit-site infection.
• Prompt dialysis catheter removal is indicated for CRB with exit-site infection caused by S. aureus due to higher complication rates and poorer outcomes.