Infections are second only to cardiovascular disease as the leading cause of morbidity and mortality among hemodialysis patients. In the United States, there is a high incidence and prevalence of tunneled dialysis catheters. The incidence and optimal treatment of catheter-associated bacteremia (CAB) have not been clearly defined. We retrospectively analyzed the outcomes of all causes of bacteremia in 62 patients with tunneled catheter access in our hemodialysis program through the period from May 1, 2000 to May 1, 2004. We compared outcomes in patients whose catheters were promptly removed (within 72 hours) vs. those who received continued antibiotic without early catheter removal (catheter salvage attempted). Catheter-associated infections were defined as positive blood cultures without another identifiable source. Data recorded for each patient included the number of catheter days, the identity of the infecting organisms, methods of treatment (catheter removal within 3 days or attempted salvage with antibiotics alone), complications and outcomes. Successful treatment was defined as non-recurrence with the same organism for at least two months post treatment. All patients with CAB were treated with at least a 14-day course of intravenous antibiotics regardless of whether the catheter was exchanged. During the 48-month study period, 62 patients developed 146 episodes of bacteremia (21.5 episodes per 1000 catheter-days). Forty of 62 patients (65%) had fever and shaking chills while on HD. 116 of 148 infections (78%) were caused by gram-positive cocci, 22 of 148 (15%) were caused by gram-negative rods, 8 (5%) gram-positive rods and two episodes (1%) were yeast infections. Attempted catheter salvage with antibiotics alone was successful in 29 of 76 episodes (38.1%) vs. 59 of 70 episodes (84.2%) who underwent catheter exchange in addition to antibiotic therapy (p < .0001, Fisher's exact test). Complications occurred in 20 of 62 patients (33.8%) with CAB. These included 9 patients with infective endocarditis, osteomyelitis in 2 patients, splenic abscess and death in 1 patient, and acute MI in 9 patients. We conclude that serious complications are common in HD patients with CAB. Attempted salvage with antibiotic therapy without catheter removal is unlikely to eradicate CAB. We conclude that prompt removal of catheter is associated with better outcome. The best treatment of CAB is prompt catheter removal.
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