Intra-catheter leukocyte culture to monitor hemodialysis catheter colonization. A prospective study to prevent catheter-related bloodstream infections
Del Pozo J.L., Aguinaga A., García-Fernández N., Hernáez S., Serrera A., Alonso M., Ramos A., Guillén-Grima F., Leiva J.
Division of Infectious Diseases and Clinical Microbiology. University Clinic of Navarra. Pamplona (Spain)
Magazine: The International Journal of Artificians Organs
Date: Sep 1, 2008Nephrology [SP] Preventive Medicine [SP] Clinical Microbiology [SP]
The most serious problem related to the use of tunneled catheters in hemodialysis is bacteremia.
The aim of this study was to detect hemodialysis catheter colonization and, establish a preemptive therapy based on a catheter antibiotic lock in order to prevent development of catheter-related bloodstream infections. During a 24-month period, all patients with tunneled catheters in our hemodialysis unit were evaluated by extracting a through-catheter leukocyte culture every 15 days. There were 28 episodes of catheter colonization occurring in 13 patients (2.2 colonization episodes per 1000 catheter patient-days). At the time of colonization, catheters had been in place for a mean of 562 days (range: 16 to 1475 days). Coagulase negative staphylococci (CNS) were the most common microorganisms to be isolated
A preemptive therapy consisting in teicoplanin locks (10 mg/mL) for 21 days was able to eradicate catheter colonization in 89% of the cases when CNS were isolated. However, relapse of colonization occurred in 61.2% of these cases. The mean duration of catheter use was 239 days (range: 9 to 483 days) after treatment of a colonization episode. The incidence of catheter-related bloodstream infection in our population was 0.78 episodes per 1000 catheter patient-days (IC 95%: 0.374-1.434).
This study shows the utility of intra-catheter leukocyte culture for early detection of hemodialysis catheter colonization. Moreover, it establishes that the eradication of biofilm-related CNS is possible without the removal of the catheter, thus enabling a longer catheter lifespan.
CITATION Int J Artif Organs. 2008 Sep;31(9):820-6
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