Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis
| Autor: | Carolyn Abitbol, Sheila Coakley, Ali Mirza Onder, Brenda Montane, Jayanthi Chandar, Gaston Zilleruelo |
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| Rok vydání: | 2005 |
| Předmět: |
Nephrology
Male medicine.medical_specialty Adolescent medicine.medical_treatment Hemodialysis Catheter Bacteremia Catheterization Predictive Value of Tests Renal Dialysis Risk Factors Internal medicine medicine Secondary Prevention Humans Child Gram-Positive Bacterial Infections Retrospective Studies business.industry Incidence (epidemiology) Retrospective cohort study medicine.disease Surgery Anti-Bacterial Agents Catheter Treatment Outcome Predictive value of tests Pediatrics Perinatology and Child Health Female Hemodialysis business Gram-Negative Bacterial Infections |
| Zdroj: | Pediatric nephrology (Berlin, Germany). 21(10) |
| ISSN: | 0931-041X |
| Popis: | Tunneled central venous catheters are often used in children on chronic hemodialysis. This study was done to evaluate the spectrum of catheter-related bacteremia (CRB) and to determine predictors of recurrent CRB in children on hemodialysis. Chart review was performed in 59 children from a pediatric dialysis unit with chronic, tunneled, cuffed hemodialysis catheters between January 1999 and December 2003. CRB was diagnosed in 48 of 59 (81%) patients. The incidence of CRB was 4.8/1,000 catheter days. Overall catheter survival (290+/-216 days) was significantly longer than infection-free catheter survival (210+/-167 days, p0.05). Organisms isolated were gram-positive in 67%, gram-negative in 14%, and polymicrobial in 19%. Systemic antibiotics cleared CRB in 34% and an additional 23% cleared with the inclusion of antibiotic-heparin locks; 43% required catheter exchange. There was a significant likelihood of early catheter exchange with polymicrobial CRB (p0.01). Catheter loss occurred from infection in 63%. Risk factors for CRB included young age (10 years) and presence of human immunodeficiency virus (HIV) infection. Patients with2 initial positive blood cultures (p0.0001) had a significantly higher rate of recurrence after 6 weeks of initial treatment. In conclusion, CRB remains a major determinant of catheter loss. However, overall catheter survival is longer than infection-free catheter survival, suggesting that systemic antibiotics with antibiotic-heparin locks should be the initial step in the management of CRB and this approach may salvage some catheters. |
| Databáze: | OpenAIRE |
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