Abstract: FR-PO760
Tunneled Catheter-Related Bacteremia Preventive Protocol: Results Analysis
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Gonzalez corvillo, Carmen, HUVMACARENA, SEVILLA, SEVILLA, Spain
- Rodriguez-Perez, Maria angeles, HUVMACARENA, SEVILLA, SEVILLA, Spain
- Salgueira, Mercedes, HUVMACARENA, SEVILLA, SEVILLA, Spain
Background
The increasing use of tunneled catheters for hemodialysis is associated with a number of complications, particularly catheter-related bacteremia(CRB).The implementation of a pre-emptive protocol during the preimplantation period and maintenance care could reduce the rate, although there is no consensus in the bibliography.Since 2006, our department has had a preimplantatory protocol,developed by nephrologists and infectologists, it includes nasal decolonization in case of staphylococcal aureus colonization, complete cleansing with chlorhexidine gel and prophylactic cefazolin before the procedure.
We analyze the results obtained in our department regarding CRB in tunneled catheter implants in the last 11 years.
Methods
Our protocol has been implemented in 246 tunneled catheters, implanted in 107 patients. Mean age:63 years. Mean follow-up period for each catheter:132 months. Incidence of bacteremia, time of appearance of the bacteremia after the implantation, bacteria types and associated complications were analyzed.
Results
- Location:right jugular vein 71.1%, left subclavian 16.3%, right subclavian 11%, femoral 1.6%
- 72 catheters were removed in 15(6.1%) cases, with infection being the main reason for removal.
- 64 cases of catheter-related bacteremia were diagnosed, representing an incidence rate of 0.48 cases per 1000catheters per day. Mean time for appearance of CRB:579+ 441 days after implantation(median 513days, minimum 42, maximum 1623)
- Most frequent microorganisms: Staph. Epidermidis 36.7%, MSSA 26.5%, MRSA 6.1% Staph. Warneri 4%, pantoea agglomerans 4%, strep viridans 4%, candida 2%, pseudomonas 2%, cloacae 2%, klebsiella 2%, corynebacterium 2%, serratia 2%.
- Infection recurrence was 26% in a mean time of 276 days. The most frequently recurring microorganisms were Staph. Epidermidis 31% and MSSA 26%.
- Septic complications: 9 cases (1 septic arthritis, 1 spondylodiscitis, 4 endocarditis and 4 septicemia)
Conclusion
In our experience, the rate of tunneled CRB is in fact lower than reported in the bibliography. Implementation of our preemptive protocol has delayed the incidence of CRB, with the primo-infection presenting more than 1 year after tunneled catheter implantation. The recurrence rate was high and the most frequent microorganism was Staph. Epidermidis. The incidence of other complications and the need to remove the catheter is low.