Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis

Ali Mirza Onder, Jayanthi Chandar, Sheila Coakley, Carolyn Abitbol, Brenda Montane, Gaston E Zilleruelo

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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, p<0.05). 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 (p<0.01). 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 with >2 initial positive blood cultures (p<0.0001) 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.

Original languageEnglish
Pages (from-to)1452-1458
Number of pages7
JournalPediatric Nephrology
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2006

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Bacteremia
Renal Dialysis
Catheters
Anti-Bacterial Agents
Central Venous Catheters
Infection
Heparin
Dialysis

Keywords

  • Catheter survival
  • Catheter-related bacteremia
  • Hemodialysis in children

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis. / Onder, Ali Mirza; Chandar, Jayanthi; Coakley, Sheila; Abitbol, Carolyn; Montane, Brenda; Zilleruelo, Gaston E.

In: Pediatric Nephrology, Vol. 21, No. 10, 01.10.2006, p. 1452-1458.

Research output: Contribution to journalArticle

Onder, Ali Mirza ; Chandar, Jayanthi ; Coakley, Sheila ; Abitbol, Carolyn ; Montane, Brenda ; Zilleruelo, Gaston E. / Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis. In: Pediatric Nephrology. 2006 ; Vol. 21, No. 10. pp. 1452-1458.
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abstract = "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, p<0.05). 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 (p<0.01). 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 with >2 initial positive blood cultures (p<0.0001) 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.",
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