Catheter-related complications and survival among incident hemodialysis patients in Singapore

Introduction: Hemodialysis is the main modality of renal replacement therapy in Singapore. However, a majority of the patients in Singapore are initiated on hemodialysis via a catheter. This study examines the complication rates and factors predicting catheter-related bloodstream infections and mortality rates in patients who were initiated on hemodialysis at our institution. Methods: This is a single-center retrospective analysis of incident hemodialysis patients who were initiated on renal replacement therapy between 1 January 2010 and 31 December 2012. Catheter-related bloodstream infection risk factors, organisms, and associated mortality were analyzed. Results: The catheter-related bloodstream infection and exit site infection incidence rates were 0.75 and 0.50 per 1000 catheter days, respectively. The mean duration to first catheter-related bloodstream infection episode was 182.47 ± 144.04 catheter days. Prolonged catheter duration was found to be a risk factor for catheter-related bloodstream infection. Compared to patients initiated on dialysis via arteriovenous fistula, initiation of dialysis via catheter is strongly associated with increased mortality (6.0% vs 14.5%; p = 0.02). In particular, the presence of diabetes mellitus and development of catheter-related bloodstream infection was associated with increased mortality ( p = 0.04 and 0.05, respectively). In addition, patients who began hemodialysis before being seen by a nephrologist were associated with decreased mortality (3.4% vs 13.0%; p = 0.03). Conclusion: In conclusion, prolonged duration of catheter insertion is found to be a risk factor for catheter-related bloodstream infection in hemodialysis patients, and its development is associated with increased mortality. Early referral to a nephrologist and creation of arteriovenous fistula in pre-end-stage renal disease patients are pivotal in improving the outcomes of patients.

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Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections

Journal of Nephrology ◽

10.1007/s40620-020-00900-3 ◽

2020 ◽

Author(s):

Marco Heidempergher ◽

Gianmarco Sabiu ◽

Maria Antonietta Orani ◽

Giovanni Tripepi ◽

Maurizio Gallieni

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Bloodstream Infections ◽

Venous Catheter ◽

Chronic Hemodialysis ◽

Infection Rates ◽

Exit Site ◽

Central Venous ◽

Exit Site Infection ◽

Catheter Related Bloodstream Infection

Abstract Background In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates. Methods An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019. Results In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81–1.68)/1000 days [2.07 (95% CI 1.12–3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51–1.24)/1000 days [1.04 (95% CI 0.41–2.15)/1000 days in the Feb–May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01–0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15–1.6)/1000 days. Conclusions The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002–0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004–1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections. Graphic abstract

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Catheter-related blood stream infection in hemodialysis patients with symmetric tunneled non-side-hole hemodialysis catheters

The Journal of Vascular Access ◽

10.1177/11297298211027058 ◽

2021 ◽

pp. 112972982110270

Author(s):

Michael G Tal ◽

Alexander S Yevzlin

Keyword(s):

Bloodstream Infection ◽

Blood Stream Infection ◽

Bloodstream Infections ◽

Blood Stream ◽

Hemodialysis Patients ◽

Side Hole ◽

Hemodialysis Catheter ◽

Catheter Tip ◽

Stage Renal Disease ◽

Catheter Related Bloodstream Infection

Background: Tunneled hemodialysis catheter-related bloodstream infection is a major cause of morbidity and mortality in end-stage renal disease patients. Side holes positioned near the tip of catheters have been linked to formation of thrombi, which, in turn, have been implicated in predisposition to infection. In addition, side holes allow spillage of catheter locking solution, including antibiotics, thereby minimizing the lock solution’s effect on the catheter tip. This study assessed the infection events that occurred in a series of hemodialysis patients using a non-side-hole catheter. Methods: Over a period of 2 years, a novel symmetric-tip non-side-hole catheter was placed in 60 patients. Hemodialysis was performed thrice weekly. Prescribed dialyzer flows were 300–350 mL/min. Catheters were routinely locked with heparin 5000 units/mL between treatments. Patients were followed up for any catheter related complications, specifically infection events. Results: Seven events of catheter-related bloodstream infection occurred for a rate of 0.76 events per 1000 catheter-days, with the first event occurring 9 weeks after insertion. These events were treated by locking the affected catheter with 2 g of clindamycin in 2 mL of heparin 1000 units/mL and administration of intravenous antibiotics, in most cases, for 7–14 days. Two catheters were removed due to infection. Conclusions: Catheter-related bloodstream infections with non-side-hole hemodialysis catheters do occur at a relatively low rate and in this initial preliminary study it seems that most of these infections can be successfully treated without removal of the affected catheters.

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Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa117 ◽

2020 ◽

Vol 7 (6) ◽

Author(s):

Kylie Martin ◽

Yves S Poy Lorenzo ◽

Po Yee Mia Leung ◽

Sheri Chung ◽

Emmet O’flaherty ◽

...

Keyword(s):

Risk Factors ◽

Bloodstream Infection ◽

Jugular Vein ◽

Insertion Site ◽

Bloodstream Infections ◽

Left Internal Jugular Vein ◽

Hemodialysis Catheter ◽

Increased Risk ◽

Reduced Risk

Abstract Diabetes and left internal jugular vein insertion site were significantly associated with increased risk of a catheter-related bloodstream infection from a tunneled hemodialysis catheter. Ex-smoker status was significantly associated with reduced risk.

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Effect of Nosocomial Bloodstream Infection on the Outcome of Critically Ill Patients with Acute Renal Failure Treated with Renal Replacement Therapy

Journal of the American Society of Nephrology ◽

10.1097/01.asn.0000110182.14608.0c ◽

2004 ◽

Vol 15 (2) ◽

pp. 454-462 ◽

Cited By ~ 63

Author(s):

E. A. J. Hoste

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Bloodstream Infection ◽

Critically Ill ◽

Critically Ill Patients ◽

Nosocomial Bloodstream Infection

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A 2% taurolidine catheter lock solution prevents catheter-related bloodstream infection (CRBSI) and catheter dysfunction in hemodialysis patients

British Journal of Nursing ◽

10.12968/bjon.2021.30.14.s24 ◽

2021 ◽

Vol 30 (14) ◽

pp. S24-S32

Author(s):

Matthias Alexander Neusser ◽

Irina Bobe ◽

Anne Hammermeister ◽

Udo Wittmann

Keyword(s):

Adverse Events ◽

Bloodstream Infection ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Technical Problems ◽

Hemodialysis Catheter ◽

Catheter Dysfunction ◽

Lock Solution ◽

Catheter Lock ◽

Catheter Related Bloodstream Infection

HIGHLIGHTS 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis Background: In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. Methods: Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. Results: No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. Conclusions: A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.

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A 2% Taurolidine Catheter Lock Solution Prevents Catheter-Related Bloodstream Infection (CRBSI) and Catheter Dysfunction in Hemodialysis Patients

Journal of the Association for Vascular Access ◽

10.2309/java-d-20-00026 ◽

2020 ◽

Vol 25 (4) ◽

pp. 48-56

Author(s):

Matthias Alexander Neusser ◽

Irina Bobe ◽

Anne Hammermeister ◽

Udo Wittmann

Keyword(s):

Bloodstream Infection ◽

Hemodialysis Patients ◽

Catheter Dysfunction ◽

Lock Solution ◽

Catheter Lock ◽

Catheter Related Bloodstream Infection

Highlights 2% Taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis.

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Colonization of the medial lumen is a risk factor for catheter-related bloodstream infection

Intensive Care Medicine ◽

10.1007/s00134-006-0247-x ◽

2006 ◽

Vol 32 (9) ◽

pp. 1404-1408 ◽

Cited By ~ 4

Author(s):

Josep-Maria Sirvent ◽

Loreto Vidaur ◽

María García ◽

Patricia Ortiz ◽

Jordi de Batlle ◽

...

Keyword(s):

Risk Factor ◽

Bloodstream Infection ◽

Catheter Related Bloodstream Infection

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Increased Catheter-Related Bloodstream Infection Rates After the Introduction of a New Mechanical Valve Intravenous Access Port

Infection Control and Hospital Epidemiology ◽

10.1086/499166 ◽

2006 ◽

Vol 27 (1) ◽

pp. 67-70 ◽

Cited By ~ 97

Author(s):

Lisa L. Maragakis ◽

Karen L. Bradley ◽

Xiaoyan Song ◽

Claire Beers ◽

Marlene R. Miller ◽

...

Keyword(s):

Bloodstream Infection ◽

Bloodstream Infections ◽

Mechanical Valve ◽

Positive Pressure ◽

Infection Rates ◽

Intravenous Catheter ◽

Access Port ◽

Intravenous Access ◽

Mechanical Valves ◽

Catheter Related Bloodstream Infection

The technology of intravenous catheter access ports has evolved from open ports covered by removable caps to more-sophisticated, closed versions containing mechanical valves. We report a significant increase in catheter-related bloodstream infections after the introduction of a new needle-free positive-pressure mechanical valve intravenous access port at our institution.

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