Routine replacement of tunneled, cuffed, hemodialysis catheters eliminates paraspinal/vertebral infections in patients with catheter-associated bacteremia

Am J Nephrol. Jul-Aug 2003;23(4):202-7. doi: 10.1159/000071479. Epub 2003 May 27.

Abstract

Background: Management of tunneled, cuffed, central venous catheters in hemodialysis (HD) patients with bacteremia remains a challenge. Attempts to salvage the catheter with systemic antibiotics alone have been associated with increased risk of metastatic infectious complications.

Methods: Retrospective case series of patients with infectious complications in a chronic dialysis unit, affiliated with a tertiary care university hospital.

Results: Between 1996 and 1999, when we treated HD catheter-associated bacteremia with systemic antibiotics alone, we encountered a clustering of 8 cases of paraspinal/vertebral infections in a population of 162 patients. After changing our protocol, i.e., routine catheter exchange over a guide wire at approximately 48 h, while on systemic antibiotic therapy, we did not encounter any new cases of paraspinal/vertebral infections over a 15-month period.

Conclusion: Our experience suggests that routine exchange of tunneled, cuffed catheters over a guide wire in HD patients presenting with bacteremia may significantly reduce serious infectious complications, e.g., epidural abscess/vertebral osteomyelitis.

MeSH terms

  • Bacteremia / etiology
  • Bacteremia / therapy*
  • Bacterial Infections / etiology
  • Bacterial Infections / prevention & control*
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / methods
  • Device Removal
  • Discitis / etiology
  • Discitis / prevention & control
  • Epidural Abscess
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Osteomyelitis / etiology
  • Osteomyelitis / prevention & control
  • Renal Dialysis / adverse effects
  • Renal Dialysis / instrumentation*
  • Retrospective Studies
  • Spinal Diseases / diagnosis
  • Spinal Diseases / etiology
  • Spinal Diseases / prevention & control*