Bacteremia associated with tunneled dialysis catheters: Comparison of two treatment strategies
Bacteremia associated with tunneled dialysis catheters: Comparison of two treatment strategies
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DOI：
10.1046/j.1523-1755.2000.00067.x
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发表时间：
2000-05-01
影响因子：
19.6
通讯作者：
Allon, M
中科院分区：
文献类型：
--
作者：
Tanriover, B;Carlton, D;Allon, M
背景隧道式透析导管通常用于血液透析患者的临时血管通路，但会因频繁的全身感染而变得复杂。与隧道导管感染相关的菌血症的治疗需要抗生素治疗和导管更换。我们比较了导管相关菌血症的两种治疗策略的结果：通过导丝将现有导管更换为新导管与延迟移除导管。我们回顾性分析了两年期间所有隧道透析导管相关菌血症病例的结局。在两组患者中评价后续导管的无感染存活时间：A组（31根导管），通过导丝将现有感染导管更换为新导管，B组（38根导管），取出感染导管，然后在3 - 10天后延迟更换导管。两个病人。两组均接受为期三周的全身抗生素治疗。采用考克斯比例风险模型分析影响导管无感染生存时间的因素。在单变量比例风险回归分析中，A组和B组更换导管的无感染生存时间相似（P = 0.72），而低白蛋白血症患者的感染风险显著更大（血清白蛋白< 3.5 g/dL），与血清白蛋白正常的患者相比（风险比2.81，95%CI，1.21，6.53，P = 0.016）。无感染生存时间不受患者年龄、性别、糖尿病状态或微生物类型（革兰阳性球菌与革兰阴性杆菌）的影响。两种治疗策略与后续导管相关的无感染生存时间相似。然而，通过导丝将导管更换为新导管可最大限度地减少患者所需的单独手术次数。低白蛋白血症是更换导管中复发性菌血症的主要风险因素。
Background. Tunneled dialysis catheters are often used for temporary vascular access in hemodialysis patients, but are complicated by frequent systemic infections. The treatment of bacteremia associated with infected tunneled catheters requires both antibiotic therapy and catheter replacement. We compared the outcomes of two treatment strategies for catheter-associated bacteremia: exchange of the existing catheter with a new one over a guidewire versus catheter removal with delayed replacement.Methods. We retrospectively analyzed the outcomes of all cases of tunneled dialysis catheter-associated bacteremia during a two-year period. The infection-free survival lime of the subsequent catheter was evaluated in two groups of patients: group A (31 catheters), exchange of the existing infected catheter with a new catheter over a guidewire, and group B (38 catheters), removal of the infected catheter followed by delayed catheter replacement 3 to 10 days later. Patients in both. groups received three weeks of systemic antibiotic therapy. Cox proportional hazard models were used to evaluate the factors predictive of infection-free survival time of the replacement catheter.Results. On univariate proportional hazard regression analysis, the infection-free survival time of the replacement catheter was similar for groups A and B (P = 0.72), whereas the hazard of infection was significantly greater for patients with hypoalbuminemia (serum albumin < 3.5 g/dL), as compared with patients with a normal serum albumin (hazard ratio 2.81, 95% CI, 1.21, 6.53, P = 0.016). The infection-free survival time was not affected by patient age, sex, diabetic status, or type of organism (gram-positive coccus vs. gram-negative rod).Conclusions. The infection-free survival time associated with the subsequent catheter is similar for the two treatment strategies. However, exchanging the catheter for a new one over a guidewire minimizes the number of separate procedures required by the patient. Hypoalbuminemia is the major risk factor for recurrent bacteremia in the replacement catheter.