Pediatric Nephrology

, Volume 21, Issue 10, pp 1452–1458 | Cite as

Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis

  • Ali Mirza Onder
  • Jayanthi ChandarEmail author
  • Sheila Coakley
  • Carolyn Abitbol
  • Brenda Montane
  • Gaston Zilleruelo
Original Article


Tunneled central venous catheters are often used in children on chronic hemodialysis. This study was done to evaluate the spectrum of catheter-related bacteremia (CRB) and to determine predictors of recurrent CRB in children on hemodialysis. Chart review was performed in 59 children from a pediatric dialysis unit with chronic, tunneled, cuffed hemodialysis catheters between January 1999 and December 2003. CRB was diagnosed in 48 of 59 (81%) patients. The incidence of CRB was 4.8/1,000 catheter days. Overall catheter survival (290±216 days) was significantly longer than infection-free catheter survival (210±167 days, p<0.05). Organisms isolated were gram-positive in 67%, gram-negative in 14%, and polymicrobial in 19%. Systemic antibiotics cleared CRB in 34% and an additional 23% cleared with the inclusion of antibiotic-heparin locks; 43% required catheter exchange. There was a significant likelihood of early catheter exchange with polymicrobial CRB (p<0.01). Catheter loss occurred from infection in 63%. Risk factors for CRB included young age (<10 years) and presence of human immunodeficiency virus (HIV) infection. Patients with >2 initial positive blood cultures (p<0.0001) had a significantly higher rate of recurrence after 6 weeks of initial treatment. In conclusion, CRB remains a major determinant of catheter loss. However, overall catheter survival is longer than infection-free catheter survival, suggesting that systemic antibiotics with antibiotic-heparin locks should be the initial step in the management of CRB and this approach may salvage some catheters.


Catheter-related bacteremia Hemodialysis in children Catheter survival 


  1. 1.
    Ramage IJ, Bailie A, Tyerman KS, McColl JH, Pollard SG, Fitzpatrick MM (2005) Vascular access survival in children and young adults receiving long-term hemodialysis. Am J Kidney Dis 45:708–715CrossRefGoogle Scholar
  2. 2.
    Lumsden AB, MacDonald MJ, Allen RC, Dodson TF (1994) Hemodialysis access in the pediatric patient population. Am J Surg 168:197–201CrossRefGoogle Scholar
  3. 3.
    Bourquelot P, Raynaud F, Pirozzi N (2003) Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases. Ther Apher Dial 7:498–503CrossRefGoogle Scholar
  4. 4.
    Gradman WS, Lerner G, Mentser M, Rodriguez H, Kamil ES (2005) Experience with autogenous arteriovenous access for hemodialysis in children and adolescents. Ann Vasc Surg 19:609–612CrossRefGoogle Scholar
  5. 5.
    Marr KA, Sexton D, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB (1997) Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 127:275–280CrossRefGoogle Scholar
  6. 6.
    Goldstein SL, Macierowski CT, Jabs K (1997) Hemodialysis catheter survival and complications in children and adolescents. Pediatr Nephrol 11:74–77CrossRefGoogle Scholar
  7. 7.
    Sharma A, Zilleruelo G, Abitbol C, Montane B, Strauss J (1999) Survival and complications of cuffed central venous catheters in children and young adults on chronic hemodialysis. Pediatr Nephrol 13:245–248CrossRefGoogle Scholar
  8. 8.
    Hymes LC, Warshaw BL, Clowers B, Newsome P, Keyserling HL (1996) Bacteremia in a pediatric hemodialysis unit secondary to Enterococcus fecalis. Pediatr Nephrol 10:55–57CrossRefGoogle Scholar
  9. 9.
    Chawla PG, Nevins TE (2000) Management of hemodialysis catheter-related bacteremia—a 10-year experience. Pediatr Nephrol 14:198–202CrossRefGoogle Scholar
  10. 10.
    Paglialonga F, Esposito S, Edefonti A, Principi N (2004) Catheter-related infections in children treated with hemodialysis. Pediatr Nephrol 19:1324–1333CrossRefGoogle Scholar
  11. 11.
    Johnson DC, Johnson FL, Goldman S (1994) Preliminary results treating persistent central venous catheter infections with the antibiotic lock technique in pediatric patients. Pediatr Infect Dis J 13:930–931CrossRefGoogle Scholar
  12. 12.
    Capdevila JA, Segarra A, Planes AM, Ramirez-Arellano M, Pahissa A, Piera L, Martinez-Vazquez JM (1993) Successful treatment of haemodialysis catheter-related sepsis without catheter removal. Nephrol Dial Transplant 8:231–234PubMedGoogle Scholar
  13. 13.
    Bailey E, Berry N, Cheesbrough JS (2002) Antimicrobial lock therapy for catheter-related bacteremia among patients on maintenance haemodialysis. J Antimicrob Chemother 50:615–617CrossRefGoogle Scholar
  14. 14.
    Krishnasami Z, Carlton D, Bimbo L, Taylor ME, Balkovetz DF, Barker J, Allon M (2002) Management of hemodialysis catheter-related bacteremia with an adjunctive lock solution. Kidney Int 61:1136–1142CrossRefGoogle Scholar
  15. 15.
    Zilleruelo G, Strauss J (1994) Management of ESRD in children with AIDS nephropathy. Semin Dial 7:454–460CrossRefGoogle Scholar
  16. 16.
    Zilleruelo G, Abitbol CL, Hubsch H, Montane B, Chandar J, Strauss J (2003) Dialysis treatment of pediatric patients infected with the human immunodeficiency virus (abstract W864). Nephrol Dial Transplant 18(Suppl 4):826Google Scholar
  17. 17.
    Abitbol CL, Friedman LB, Zilleruelo G (2005) Renal manifestations of sexually transmitted diseases: sexually transmitted diseases and the kidney. Adolesc Med Clin 16:45–65CrossRefGoogle Scholar
  18. 18.
    O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA, Healthcare Infection Control Practices Advisory Committee (2002) Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23:759–769CrossRefGoogle Scholar
  19. 19.
    Chalumeau M, Tonnelier S, d’Athis P, Treluyer JM, Gendrel D, Breat G, Pons G, The Pediatric Fluoroquinolone Safety Study Investigators (2003) Flouroquinolone safety in pediatric patients: a prospective, multicenter, comparative cohort study in France. Pediatrics 111:e714–e719CrossRefGoogle Scholar
  20. 20.
    Dasgupta MK (2002) Biofilms and infection in dialysis patients. Semin Dial 15:338–346CrossRefGoogle Scholar
  21. 21.
    Costerton JW, Philip SS, Greenberg EP (1999) Bacterial biofilms: a common cause of persistent infections. Science 284:1318–1322CrossRefGoogle Scholar
  22. 22.
    Donlan RM (2001) Biofilm formation: a clinically relevant microbiological process. Clin Infect Dis 33:1387–1392CrossRefGoogle Scholar
  23. 23.
    Hoen B, Kessler M, Hestin D, Mayeux D (1995) Risk factors for bacterial infections in chronic hemodialysis adult patients: a multicenter prospective survey. Nephrol Dial Transplant 10:377–381PubMedGoogle Scholar
  24. 24.
    Jean G, Charra B, Chazot C, Vanel T, Terrat JC, Hurot JM, Laurent G (2002) Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias. Nephron 91:399–405CrossRefGoogle Scholar
  25. 25.
    Kaplowitz LG, Comstock JA, Landwehr DM (1988) A prospective study of infections in hemodialysis patients: patient hygiene and other risk factors for infection. Infect Control Hosp Epidemiol 9:534–541CrossRefGoogle Scholar
  26. 26.
    Brewster UC, Coca SG, Reilly RF, Perazella MA (2005) Effect of intravenous iron on haemodialysis catheter microbial colonization and blood-borne infection. Nephrology (Carlton) 10:124–128CrossRefGoogle Scholar
  27. 27.
    Sirken G, Raja R, Rizkala AR (2004) Identification of infectious risk factors in maintenance hemodialysis patients: the role of intravenous iron. J Am Soc Nephrol 15:627AGoogle Scholar
  28. 28.
    Churchill DN, Taylor DW, Cook RJ (1992) Canadian hemodialysis morbidity study. Am J Kidney Dis 19:214–234CrossRefGoogle Scholar
  29. 29.
    Powe NR, Jaar B, Furth SL (1999) Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int 55:1081–1090CrossRefGoogle Scholar
  30. 30.
    Tanriover B, Carlton D, Saddekni S, Hamrick K, Oser R, Westfall A, Allon M (2000) Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int 57:2151–2155CrossRefGoogle Scholar
  31. 31.
    2003 Annual Report (2004) ESRD Clinical Performance Measures Project. Opportunities to improve care for adult in-center hemodialysis, adult peritoneal dialysis, and pediatric in-center hemodialysis patients. Am J Kidney Dis 44 (Suppl 2): 44–52Google Scholar
  32. 32.
    Neu MA, Ho PL, McDonald RA, Warady BA (2002) Chronic dialysis in children and adolescents. The 2001 NAPRTCS Annual Report. Pediatr Nephrol 17:656–663CrossRefGoogle Scholar

Copyright information

© IPNA 2006

Authors and Affiliations

  • Ali Mirza Onder
    • 1
  • Jayanthi Chandar
    • 1
    • 2
    Email author
  • Sheila Coakley
    • 3
  • Carolyn Abitbol
    • 1
  • Brenda Montane
    • 1
  • Gaston Zilleruelo
    • 1
  1. 1.Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children’s HospitalUniversity of MiamiMiamiUSA
  2. 2.Division of Pediatric NephrologyUniversity of Miami, Holtz Children’s HospitalMiamiUSA
  3. 3.Department of Pediatrics, Division of Pediatric NephrologyHoltz Children’s Hospital, Pediatric Dialysis unitMiamiUSA

Personalised recommendations