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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

Abstract

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.

Keywords

Catheter-related bacteremia Hemodialysis in children Catheter survival 

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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

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