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Infection in Haemodyalisis Catheters: a Retrospective Examination
Infección de catéteres de hemodiálisis: una revisión retrospectiva
Mónica Raquel Rodrigues Fructuosoa, Rui Castroa, Luís Oliveiraa, Catarina Prataa, Teresa Morgadoa
a Serviço de Nefrologia, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE Oporto, Oporto, Portugal,
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Central venous catheter infections are an important cause of morbidity and mortality in patients on haemodialysis&#46; The KDOQI describes an infection frequency of between 3&#46;8 and 6&#46;6 episodes&#47;1&#44;000 days of catheter for non-tunnelled catheters and between 1&#46;6 to 5&#46;5&#47;1&#44;000 days of catheter for tunnelled catheters&#46;<span class="elsevierStyleSup">1</span> The frequency of bacteraemia varies in various studies between 1&#46;6 and 7&#46;7&#47;1&#44;000 days of catheter for non-tunnelled catheters and between 0&#46;2 and 0&#46;5&#47;1&#44;000 days of catheter for tunnelled catheters&#46;<span class="elsevierStyleSup">2-6</span></p><p class="elsevierStylePara">Our goal was to review the catheter infections in our Haemodialysis Unit&#46; Patients and methods&#58; we examined the catheter infections over a period of six years &#40;1 January 2001 to 31 December 2006&#41;&#46; We have implanted 168 catheters&#44; 90 of which were nontunnelled and 78 tunnelled&#44; in 70 patients&#46; Mean age at the time of catheter implantation was 70 &#177; 14 years old and the average time on haemodialysis 10 months &#40;1 day-17 years&#41;&#46; Approximately 25&#46;7&#37; of the patients suffered from kidney disease of unknown aetiology and 22&#46;8&#37; had diabetic nephropathy&#46; Cephazolin was administered before the implantation of tunnelled catheters in all the cases&#46;</p><p class="elsevierStylePara">Results&#58; The tunnelled catheters were left in place for a median time of 4 &#40;0-45&#41; months and the non-tunnelled catheters were left for 1 &#40;1-6&#41; months&#46; Diabetic patients did not experience more infections &#40;32&#46;4 vs&#46; 34&#46;2&#37;&#59; p &#61; NS&#41; or bacteraemia &#40;2&#46;6 vs&#46; 3&#46;8&#37;&#59; p &#61; NS&#41; than the rest of the patients&#46; The incidence of infections was 2&#46;33&#47;1&#44;000 days of catheter for nontunnelled catheters and 3&#46;10&#47;1&#44;000 days of catheter for tunnelled catheters &#40;p &#61; NS&#41;&#46; The most frequent type of infection was that of the exit site both in tunnelled catheters &#40;44&#47;57 &#91;77&#46;2&#37;&#93;&#41; and non-tunnelled catheters &#40;7&#47;9 &#40;77&#46;8&#37;&#93;&#41;&#59; p &#61; NS&#46; The incidence of bacteraemia of the non-tunnelled catheters was not greater than that of the tunnelled catheters &#40;0&#46;78&#47;1&#46;000 versus 0&#46;22&#47;1&#44;000 days of catheter&#59; p &#61; 0&#46;08&#41;&#46; Twenty-one tunnelled catheters &#40;26&#46;9&#37;&#41; were implanted over a guidewire in non-tunnelled catheters but these did not suffer more infections &#40;8&#47;29 versus 13&#47;49&#44; p &#61; NS&#41;&#46;</p><p class="elsevierStylePara">Cephazolin &#40;55&#46;3&#37;&#41; was the empiricallyusedantibiotic in the majority of the infections&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Staphylococcus</span> was the predominant type&#44; identified in blood cultures in 100&#37; of the cases and in 79&#46;2&#37; of the exit site swabs&#46; The prevalence of Methicillinresistant species was 60&#37;&#46;</p><p class="elsevierStylePara">After the microbiological results&#44; the initial antibiotic was changed in 22&#46;7&#37; of the cases &#40;N &#61; 15&#41;&#46; In almost half of them &#40;46&#46;7&#37;&#41; the antibiotic was switched to Vancomycin&#46;</p><p class="elsevierStylePara">All patients with sepsis &#40;N &#61; 9&#41; were hospitalized&#46; One died of septic shock and the rest recovered fully&#46;</p><p class="elsevierStylePara">Conclusions&#58; The non-tunnelled catheters were used for one month without any negative impact on the number of infections&#46; In our opinion&#44; they are safe as a temporary access site for patients that are waiting for the construction or maturing of a definitive access&#46;</p><p class="elsevierStylePara">Due to the high prevalence of Methicillinresistant species in our centre led to the subsequent inclusion of Vancomycin in our protocol for the management of catheter infections&#46;</p>"
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Article information
ISSN: 20132514
Original language: English
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Idiomas
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