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[Infections on catheters in hemodialysis: Temporal fluctuations of the infectious risk]
S Izoard1, L Ayzac2, J Meynier3
1Service d'hygiène hospitalière, centre hospitalier Compiègne-Noyon, 8, avenue Henri-Adnot, ZAC de Mercières 3, 60200 Compiègne, France.
Insights
Infectious risk for tunneled catheters is highest in the first few months after placement, then declines. Preventive measures should focus on this initial period to reduce complications in hemodialysis patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Devices
Background:
- International guidelines advise limiting long-term central venous catheter use in hemodialysis due to infection risk.
- Permanent vascular access is not feasible for all patients, necessitating prolonged catheter use.
- The temporal profile of infectious risk with catheters requires further study.
Purpose of the Study:
- To investigate the influence of prolonged catheterization duration on infectious complications.
- To analyze the temporal fluctuation of infectious risk in patients with tunneled catheters.
Main Methods:
- A multicentric prospective study involving 1053 incident tunneled catheters.
- Multivariate logistic regression to identify significant infection risk factors.
- Infection-free survival analysis to assess the instantaneous infectious risk variation over time.
Main Results:
- Key risk factors for infection included previous Staphylococcus aureus infection, diabetes, and prolonged catheterization (≥24 months vs. 0-3 months).
- Survival analysis indicated a higher risk of infection in the initial months post-placement.
- The infectious risk demonstrated a declining trend over the catheterization period.
Conclusions:
- The infectious risk associated with tunneled catheters is not constant over time.
- Preventive strategies should prioritize the early phase of catheterization to mitigate infection risk.
Background:
International guidelines recommend to limit the long-term use of central-veinous catheters in patients undergoing hemodialysis, because they expose the patient to a higher infectious risk than the fistulas. However, for some patients with comorbidity, switching to a permanent vascular access is not possible. In such case, the catheter is used for a longer period. It seems therefore important to study the influence of a prolonged duration of catheterization on infectious complications. The temporal fluctuation profile of the infectious risk is poorly studied in the literature and the results published may be contradictory.
Methods:
This multicentric prospective study included 1053 incident tunneled catheters. Multivariate logistic regression was used to identify significant risk factors of infection. An infection-free survival analysis was performed afterwards to estimate the variation of the instantaneous infectious risk during catheterization.
Results:
The major risks factors of infections on tunneled catheters were: previous Staphylococcus aureus infection (aOR=1.95 [1.16-3.27]; P=0.012), diabetes (aOR=1.67 [1.16-2.41]; P=0.006), and long duration of catheterization (0-3months vs.≥24months: aOR=2.42 [1.34-4.36]; P=0.003). The survival analysis showed a higher risk of infections of tunneled catheters during the first months after placement. Risk declines over time.
Conclusions:
The fluctuation profile of the infectious risk show that preventive precautions should target the first months of catheterization.
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