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Central venous catheter-related bacteremia in chronic hemodialysis patients: epidemiology and evidence-based management

Nature Clinical Practice Nephrology volume 3, pages 256–266 (2007)Cite this article

Abstract

Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients with end-stage renal disease treated with chronic hemodialysis. Risk factors include Staphylococcus aureus nasal colonization, longer duration of catheter use, previous bacteremia, older age, higher total intravenous iron dose, lower hemoglobin and serum albumin levels, diabetes mellitus and recent hospitalization. Symptoms that raise clinical suspicion of bacteremia in chronic hemodialysis patients are fevers and chills. When CRBSI is suspected, blood cultures should be obtained and empirical therapy with broad spectrum intravenous antibiotics initiated. The diagnosis of CRBSI is confirmed by isolation of the same microorganism from quantitative cultures of both the catheter and the peripheral blood of a patient that has clinical features of infection without any other apparent source. Gram-positive cocci, predominantly S. epidermidis and S. aureus, cause bacteremia in two-thirds of cases. Among the various approaches to management of CRBSI, removal and delayed replacement of the catheter, catheter exchange over a guidewire in selected patients, and the use of antimicrobial/citrate lock solutions have all been found to be promising for treatment and/or prevention; however, resolution of issues regarding selection, dose, duration and emergence of antibiotic-resistant organisms with chronic use of antibiotic lock solutions, as well as the safety of long-term use of trisodium citrate lock solutions, await further randomized, multicenter trials involving larger samples of hemodialysis patients.

Key Points

  • Central venous catheter-related blood stream infection (CRBSI)—most often with Staphylococcus aureus or S. epidermis—is a common complication and cause of death among maintenance hemodialysis patients

  • Diagnosis of CRBSI is confirmed by isolation of the same microorganism from quantitative cultures of both the catheter and the peripheral blood of a patient that has clinical features of infection without any other apparent source

  • Choice of antibiotics for initial empirical treatment of CRBSIs is a major management decision, as is determining whether catheter removal is appropriate

  • Topical antibiotics and catheter-lock solutions are the primary means of preventing CRBSIs, but risk of antibiotic-resistant organism emergence should be considered

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Figure 1: Relationships between factors associated with hemodialysis central venous catheter-related blood stream infections
Figure 2: Management of central venous hemodialysis catheter-related bacteremia

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Acknowledgements

The views expressed in this article are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, R Katneni is a Nephrology Fellow at the University of Texas Southwestern Medical Center, and SS Hedayati is an Assistant Professor of Medicine at the University of Texas Southwestern Medical Center and a Staff Nephrologist at the Veterans Affairs North Texas Healthcare System, Dallas, TX, USA.,

    Ratnaja Katneni & S Susan Hedayati

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Correspondence to S Susan Hedayati.

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Katneni, R., Hedayati, S. Central venous catheter-related bacteremia in chronic hemodialysis patients: epidemiology and evidence-based management. Nat Rev Nephrol 3, 256–266 (2007). https://doi.org/10.1038/ncpneph0447

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