Treatment of PermCath-related sepsis in uremic patients

Patients who use PermCath as the vascular access for long-term hemodialysis are occasionally confronted with catheter-related infections. Recently, we have treated 17 patients suffering from PermCath-related sepsis. The clinical presenting features were leukocytosis in 14/17, high fever and shaking chill during dialysis in 12/17, and signs of exit site infection in 3/17. No shock was found. All patients received clinical evaluation to exclude infection sources other than from blood and inside the catheter, such as pulmonary, genitourinary, hepatobiliary and cutaneous systems. Blood drawn from both PermCath and peripheral vein was sent for bacterial culture. Bacterial culture of the blood samples from PermCath revealed Staphylococcus sp. in 7/17, Pseudomonas sp. in 5/17, Enterobacter sp. in 4/17, Streptococcus sp. in 1/17. Fourteen blood samples from peripheral vein showed positive culture results identical to those from PermCath, but negative study were noted in three other patients. The patients were divided into two treatment groups: Group I: systemic antibiotics without PermCath removal in 7, Group II: "locked-in" retention in addition to systemic anti-biotics in 10. Antibiotics were empirically chosen according to bacteriological studies. In the "locked-in" retention treatment, antibiotics were retained into both the inflow and outflow PermCath lumens in the exact volume of each lumen for 24 hours. The antibiotics solutions were replaced on a daily basis. The same antibiotics were also given intravenously. Duration of treatment depended on clinical progression and follow-up blood culture results and ranged between 13 and 24 days. The schedule of dialysis was not changed through the period of PermCath-related sepsis. The sepsis was cured in all group II cases but not in 2 of group I and resulted in mortality in these 2 patients. The PermCaths were preserved in 5/7 in group I with two mortality cases and all except one preserved in group II patients without mortality. We suggested that "locked-in" retention in addition to systemic antibiotics is the treatment of choice for the patients with PermCath-related sepsis. This method also preserves the functional integrity of PermCath, which is the lifeline vascular access of the patients with exhausted native vessels.