An Interventional Controlled Trial Comparing 2 Management Models for the Treatment of Tunneled Cuffed Catheter Bacteremia: A Collaborative Team Model Versus Usual Physician-Managed Care

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Abstract

Background: The management of tunneled cuffed catheter (TCC)-associated bacteremias varies among nephrologists. To determine whether patient outcomes after TCC-associated bacteremia can be improved by modifying the management model, we performed an interventional controlled trial comparing a collaborative team model, intervention (INT), with the usual physician-managed model, usual care (UC). Methods: INT consisted of an infection manager who worked closely with nephrologists and dialysis staff and made treatment recommendations using the available published guidelines at the time of the study's conception (Dialysis Outcomes Quality Initiative guideline no. 26, 1997) and additional literature-based recommendations. Nephrologists made the final treatment decisions. TCC-associated bacteremia was physician managed in the UC group. Results: Two hundred twenty-three episodes of TCC-associated bacteremia occurred in 7 outpatient hemodialysis units during the 21/2-year study period. The INT was associated with a significantly lower incidence of recurrent bacteremia with the same organism (INT, 6% versus UC, 18%; odds ratio, 0.28; 95% confidence interval, 0.09 to 0.8; P = 0.015) and death from sepsis (INT, 0% versus UC, 6%; P < 0.02). In INT units, there was a 45% decrease in the practice of TCC salvage (TCC not removed; P = 0.05). Antibiotic prescribing practices (final antibiotic selection, dose, and duration of therapy) were improved in INT units compared with UC units. By using multivariate analysis, the INT was associated with a 73% decrease in the combined outcome of recurrent bacteremia or septic death (P < 0.02). Conclusion: Implementation of a collaborative team model for the management of TCC-associated bacteremic episodes is associated with improvement in the quality of heath care delivery and patient outcomes.

Original languageEnglish (US)
Pages (from-to)587-595
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume48
Issue number4
DOIs
StatePublished - Oct 2006

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Managed Care Programs
Bacteremia
Catheters
Physicians
Therapeutics
Dialysis
Guidelines
Anti-Bacterial Agents
Time and Motion Studies
Quality of Health Care
Renal Dialysis
Sepsis
Outpatients
Multivariate Analysis
Odds Ratio
Confidence Intervals
Incidence
Infection
Nephrologists

Keywords

  • bacteremia
  • health care team effectiveness
  • hemodialysis (HD)
  • Tunneled catheter

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{aa7dfd96030d41c5a8485ebc37bb85b5,
title = "An Interventional Controlled Trial Comparing 2 Management Models for the Treatment of Tunneled Cuffed Catheter Bacteremia: A Collaborative Team Model Versus Usual Physician-Managed Care",
abstract = "Background: The management of tunneled cuffed catheter (TCC)-associated bacteremias varies among nephrologists. To determine whether patient outcomes after TCC-associated bacteremia can be improved by modifying the management model, we performed an interventional controlled trial comparing a collaborative team model, intervention (INT), with the usual physician-managed model, usual care (UC). Methods: INT consisted of an infection manager who worked closely with nephrologists and dialysis staff and made treatment recommendations using the available published guidelines at the time of the study's conception (Dialysis Outcomes Quality Initiative guideline no. 26, 1997) and additional literature-based recommendations. Nephrologists made the final treatment decisions. TCC-associated bacteremia was physician managed in the UC group. Results: Two hundred twenty-three episodes of TCC-associated bacteremia occurred in 7 outpatient hemodialysis units during the 21/2-year study period. The INT was associated with a significantly lower incidence of recurrent bacteremia with the same organism (INT, 6{\%} versus UC, 18{\%}; odds ratio, 0.28; 95{\%} confidence interval, 0.09 to 0.8; P = 0.015) and death from sepsis (INT, 0{\%} versus UC, 6{\%}; P < 0.02). In INT units, there was a 45{\%} decrease in the practice of TCC salvage (TCC not removed; P = 0.05). Antibiotic prescribing practices (final antibiotic selection, dose, and duration of therapy) were improved in INT units compared with UC units. By using multivariate analysis, the INT was associated with a 73{\%} decrease in the combined outcome of recurrent bacteremia or septic death (P < 0.02). Conclusion: Implementation of a collaborative team model for the management of TCC-associated bacteremic episodes is associated with improvement in the quality of heath care delivery and patient outcomes.",
keywords = "bacteremia, health care team effectiveness, hemodialysis (HD), Tunneled catheter",
author = "Mokrzycki, {Michele H.} and Meilin Zhang and Ladan Golestaneh and Jeffrey Laut and Rosenberg, {Stuart O.}",
year = "2006",
month = "10",
doi = "10.1053/j.ajkd.2006.06.009",
language = "English (US)",
volume = "48",
pages = "587--595",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "4",

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TY - JOUR

T1 - An Interventional Controlled Trial Comparing 2 Management Models for the Treatment of Tunneled Cuffed Catheter Bacteremia

T2 - A Collaborative Team Model Versus Usual Physician-Managed Care

AU - Mokrzycki, Michele H.

AU - Zhang, Meilin

AU - Golestaneh, Ladan

AU - Laut, Jeffrey

AU - Rosenberg, Stuart O.

PY - 2006/10

Y1 - 2006/10

N2 - Background: The management of tunneled cuffed catheter (TCC)-associated bacteremias varies among nephrologists. To determine whether patient outcomes after TCC-associated bacteremia can be improved by modifying the management model, we performed an interventional controlled trial comparing a collaborative team model, intervention (INT), with the usual physician-managed model, usual care (UC). Methods: INT consisted of an infection manager who worked closely with nephrologists and dialysis staff and made treatment recommendations using the available published guidelines at the time of the study's conception (Dialysis Outcomes Quality Initiative guideline no. 26, 1997) and additional literature-based recommendations. Nephrologists made the final treatment decisions. TCC-associated bacteremia was physician managed in the UC group. Results: Two hundred twenty-three episodes of TCC-associated bacteremia occurred in 7 outpatient hemodialysis units during the 21/2-year study period. The INT was associated with a significantly lower incidence of recurrent bacteremia with the same organism (INT, 6% versus UC, 18%; odds ratio, 0.28; 95% confidence interval, 0.09 to 0.8; P = 0.015) and death from sepsis (INT, 0% versus UC, 6%; P < 0.02). In INT units, there was a 45% decrease in the practice of TCC salvage (TCC not removed; P = 0.05). Antibiotic prescribing practices (final antibiotic selection, dose, and duration of therapy) were improved in INT units compared with UC units. By using multivariate analysis, the INT was associated with a 73% decrease in the combined outcome of recurrent bacteremia or septic death (P < 0.02). Conclusion: Implementation of a collaborative team model for the management of TCC-associated bacteremic episodes is associated with improvement in the quality of heath care delivery and patient outcomes.

AB - Background: The management of tunneled cuffed catheter (TCC)-associated bacteremias varies among nephrologists. To determine whether patient outcomes after TCC-associated bacteremia can be improved by modifying the management model, we performed an interventional controlled trial comparing a collaborative team model, intervention (INT), with the usual physician-managed model, usual care (UC). Methods: INT consisted of an infection manager who worked closely with nephrologists and dialysis staff and made treatment recommendations using the available published guidelines at the time of the study's conception (Dialysis Outcomes Quality Initiative guideline no. 26, 1997) and additional literature-based recommendations. Nephrologists made the final treatment decisions. TCC-associated bacteremia was physician managed in the UC group. Results: Two hundred twenty-three episodes of TCC-associated bacteremia occurred in 7 outpatient hemodialysis units during the 21/2-year study period. The INT was associated with a significantly lower incidence of recurrent bacteremia with the same organism (INT, 6% versus UC, 18%; odds ratio, 0.28; 95% confidence interval, 0.09 to 0.8; P = 0.015) and death from sepsis (INT, 0% versus UC, 6%; P < 0.02). In INT units, there was a 45% decrease in the practice of TCC salvage (TCC not removed; P = 0.05). Antibiotic prescribing practices (final antibiotic selection, dose, and duration of therapy) were improved in INT units compared with UC units. By using multivariate analysis, the INT was associated with a 73% decrease in the combined outcome of recurrent bacteremia or septic death (P < 0.02). Conclusion: Implementation of a collaborative team model for the management of TCC-associated bacteremic episodes is associated with improvement in the quality of heath care delivery and patient outcomes.

KW - bacteremia

KW - health care team effectiveness

KW - hemodialysis (HD)

KW - Tunneled catheter

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