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Kidney Week

Abstract: SA-PO1094

Long-Term Outcomes of Catheter-Related Bloodstream Infections

Session Information

  • Vascular Access - II
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Lee Loy, Justin, University of Florida, Gainesville, Florida, United States
  • Chamarthi, Gajapathiraju, University of Florida, Gainesville, Florida, United States
  • Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States
  • Cherabuddi, Kartikeya, University of Florida, Gainesville, Florida, United States
  • Mohandas, Rajesh, University of Florida, Gainesville, Florida, United States
Background

Catheter-related bloodstream infections (CRBSIs) are common in patients receiving hemodialysis through a central venous catheter. In addition to antibiotics, treatment may include replacement of the catheter, exchange over a guide wire, or the catheter maybe left unchanged (salvage therapy). While these modalities are equally efficacious in the short run, the effect on long term infectious complications like endocarditis and epidural abscesses is not known. The purpose of our study was to determine the long-term complications of CRBSI and determine if catheter salvage or exchange is associated with an increased risk of long-term complications.

Methods

We retrospectively studied 100 randomly selected adult patients on hemodialysis admitted to a 1000 bed academic university hospital between May 1st, 2010 and April 30th, 2017 with CRBSI. Baseline demographics and clinical characteristics were stratified by line disposition. Multivariable logistic regression models were used to analyze the association between line disposition and long-term complications, adjusted for age, intensive care unit admission, and isolated organism.

Results

The mean age was 59.6 ± 15.7 years with 36% males and 64% females. Methicillin-resistant Staphylococcus aureus (MRSA) was the most common organism isolated (26%). 45% of catheters were replaced, 43% were exchanged, and 12%were salvaged. After excluding those who died and had catheter discontinued, 28% of the 75 patients developed long term complications. The long-term complications rates were 40% for catheter salvage, 32% for replacement and 21% for exchange (p=0.383). In univariate analysis there was no difference between groups. However, when adjusted for age, organism and ICU stay, patients with catheter exchange were less likely to develop long term complications compared to those with salvage therapy (adjusted OR: 0.14; 95%CI: 0.02-0.83). There was no statistically significant difference between the other groups.

Conclusion

Our results showed that there is a high incidence of long-term complications in patients admitted with CRBSI. The incidence was highest in those with catheter salvage. These results suggest the need for caution with catheter salvage and an adequately powered randomized controlled trial to determine the long-term safety of catheter salvage in patients with CRBSI.