Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis

Ann Intern Med. 1997 Aug 15;127(4):275-80. doi: 10.7326/0003-4819-127-4-199708150-00003.


Background: Dual-lumen cuffed catheters are used for vascular access in patients undergoing hemodialysis. The incidence and appropriate management of catheter-related bacteremia are unknown.

Objective: To determine the incidence and outcome of catheter-related bacteremia and to assess the efficacy of catheter salvage.

Design: Prospective, observational study.

Setting: University hospital inpatient service and four affiliated outpatient dialysis units.

Patients: 102 patients with end-stage renal disease who underwent hemodialysis with dual-lumen cuffed catheters between 1 April 1995 and 1 January 1996.

Measurements: Number of days that the catheter remained in situ, treatment (catheter removal or attempted salvage with antibiotic therapy), and outcome of bacteremia. Microbiological cultures were done to identify catheter-related bacteremia.

Results: 102 patients had a total of 16,081 catheter-days. Forty-one patients (40%) developed 62 episodes of bacteremia (3.9 episodes per 1000 catheter-days [95% CI, 3.0 to 4.9 episodes per 1000 catheter-days]). Twenty-four catheters (39%) were removed immediately, and 38 (61%) were left in place during treatment. Only 12 (32%) of the 38 catheters were salvaged successfully. Salvage was less likely to succeed in patients with gram-positive bacteremia than in patients with gram-negative bacteremia, but this difference was not statistically significant (P = 0.14). Nine of the 41 patients (22%) who developed bacteremia had the following complications: osteomyelitis (6 patients), septic arthritis (1 patient), infective endocarditis (4 patients), and death (2 patients). All complications followed an episode of gram-positive bacteremia, and none was associated with attempted catheter salvage.

Conclusions: Bacteremia frequently occurs in patients undergoing hemodialysis with dual-lumen catheters. Antibiotic therapy without catheter removal is unlikely to eradicate catheter-related bacteremia in these patients, but attempted salvage may not increase the risk for complications.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Bacteremia / etiology*
  • Bacteremia / microbiology
  • Bacteremia / therapy*
  • Catheters, Indwelling / adverse effects
  • Female
  • Gram-Negative Bacteria / isolation & purification
  • Gram-Positive Bacteria / isolation & purification
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Outpatients
  • Prospective Studies
  • Recurrence
  • Renal Dialysis*
  • Risk
  • Treatment Outcome