Central venous catheter-related bacteremia in chronic hemodialysis patients: epidemiology and evidence-based management

摘要: Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients with end-stage renal disease treated chronic hemodialysis. Risk factors include Staphylococcus aureus nasal colonization, longer duration catheter use, previous bacteremia, older age, higher total intravenous iron dose, lower hemoglobin serum albumin levels, diabetes mellitus recent hospitalization. Symptoms that raise clinical suspicion bacteremia hemodialysis are fevers chills. When CRBSI suspected, cultures should be obtained empirical therapy broad spectrum antibiotics initiated. The diagnosis confirmed by isolation the same microorganism from quantitative both peripheral patient has features without any other apparent source. Gram-positive cocci, predominantly S. epidermidis aureus, two-thirds cases. Among various approaches to management CRBSI, removal delayed replacement catheter, exchange over guidewire selected patients, use antimicrobial/citrate lock solutions have all been found promising for treatment and/or prevention; however, resolution issues regarding selection, emergence antibiotic-resistant organisms antibiotic solutions, as well safety long-term trisodium citrate await further randomized, multicenter trials involving larger samples patients.