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Infection of hemodialysis catheters: incidence and mechanisms
J Almirall1, J Gonzalez, J Rello
1Department of Nephrology, Hospital Clínic i Provincial, Barcelona, Spain.
Abstract:
Fifty-three consecutive subclavian or jugular hemodialysis catheters inserted into 41 patients were prospectively studied over a period of 8 months in order to determine the incidence of infection and its mechanisms. The intravascular, intradermal and the Y catheter segments as well as both connections were cultured using a quantitative technique for the intraluminal surface. In addition, the intravascular and intradermal portions of the catheter were cultured using a semiquantitative technique for the external surface. Skin smears of the catheter entry site were also cultured, and blood cultures were similarly obtained if fewer developed. Twenty-nine of the 53 catheters (55%) were significantly colonized by one (19 cases) or more (10 cases) microorganisms. The source of the colonizing microorganisms was the skin in 17 cases (58%), intraluminal in 5 (17%), both routes in 5 (17%) and others in 2 (6.8%). Staphylococcus epidermidis (22 cases) and Staphylococcus aureus (4 cases) were the bacteria most frequently isolated. Nine of the 53 catheterizations (17%) were complicated by catheter-related septicemia due to S. aureus in 4 cases, S. epidermidis in 3 cases, Streptococcus faecalis in 1 and Proteus vulgaris in 1. Catheter-related bacteremia contributed to a patient's death in 1 case. Suppurative local infections of the catheter entry site developed in 3 cases, 2 of them with septicemia. We conclude that the rate of infection due to subclavian or jugular hemodialysis catheters is very high and that the skin is the most frequent origin of the microorganisms.
Insights
The study found a high infection rate in hemodialysis catheters, with over half showing significant colonization. Skin is the primary source of these infections, highlighting the need for improved catheter site care.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Devices
Background:
- Subclavian and jugular hemodialysis catheters are crucial for renal replacement therapy.
- Catheter-related infections pose a significant risk to patient safety and treatment efficacy.
Purpose of the Study:
- To prospectively determine the incidence and mechanisms of infection associated with hemodialysis catheters.
- To identify the primary sources of microbial colonization in these devices.
Main Methods:
- Prospective study of 53 hemodialysis catheters in 41 patients over 8 months.
- Quantitative and semiquantitative cultures of catheter segments (intravascular, intradermal, Y-piece) and connections.
- Cultures of skin entry sites and blood cultures when indicated.
Main Results:
- 55% of catheters showed significant microbial colonization.
- Skin was the most frequent source (58%), followed by intraluminal contamination (17%).
- Common isolates included Staphylococcus epidermidis and Staphylococcus aureus; 17% of catheterizations resulted in septicemia.
Conclusions:
- Hemodialysis catheter infection rates are notably high.
- Skin contamination is the predominant route for catheter colonization and subsequent infection.
- Effective prevention strategies should focus on meticulous skin antisepsis at the catheter insertion site.