[Vascular access infection in patients on hemodialysis]

Area of Science:

• Infectious Diseases
• Microbiology
• Medical Devices

Context:

• Catheter use is associated with serious infections, high complication, and mortality rates.
• Gram-positive cocci, especially Staphylococcus aureus and coagulase-negative staphylococci, are primary causes of bloodstream infections.
• Increasing drug-resistant bacteria complicate infection management.

Purpose:

• To review the challenges and strategies for managing catheter-related bloodstream infections (CRBSIs).
• To differentiate treatment approaches based on the causative pathogen, Staphylococcus aureus versus coagulase-negative staphylococci.
• To assess the feasibility of catheter preservation in different bacterial infection scenarios.

Summary:

• Catheter-associated bloodstream infections are a major concern, with Gram-positive cocci being the predominant pathogens.
• Treatment success, including catheter preservation, varies significantly depending on the specific bacteria involved.
• Coagulase-negative staphylococci infections may allow for catheter preservation with combined antibiotic lock therapy and systemic antibiotics.
• Staphylococcus aureus bloodstream infections rarely permit catheter preservation due to high relapse rates and severe associated complications like endocarditis and osteomyelitis.

Impact:

• Highlights the critical need for targeted antimicrobial strategies in managing CRBSIs.
• Informs clinical decision-making regarding catheter management and preservation.
• Underscores the challenges posed by antibiotic resistance in treating Gram-positive bacterial infections associated with medical devices.