Favourable outcomes in episodes of Pseudomonas bacteraemia when associated with tunnelled cuffed catheters (TCCs) in chronic haemodialysis patients

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Abstract

Background. Pseudomonas is regarded as a particularly lethal bacterial isolate. High mortality rates have been reported in episodes of Pseudomonas sepsis when associated with visceral infections as seen in immunosuppressed, hospitalized patients. In comparison, lower mortality rates have been reported with catheter-associated Pseudomonas bacteraemia in non-dialysis patients. The purpose of this study was to determine the risk factors and the outcomes for episodes of Pseudomonas bacteraemia associated with the use of tunnelled cuffed haemodialysis catheters (TCCs) in a chronic out-patient population. Methods. We performed a prospective observational study in seven chronic haemodialysis units over a 2.5 year period. Patients who were diagnosed as having their initial TCC-associated bacteraemia within the study period were followed for 3 months. All episodes of Pseudomonas TCC bacteraemia were identified, and univariate analyses were performed to compare Pseudomonas bacteraemia with non- Pseudomonas bacteraemia. Results. During the study period, 219 episodes of TCC bacteraemia were identified; 18 had a Pseudomonas isolate (8%). Pseudomonas bacteraemia episodes were associated with a significantly higher risk of not receiving appropriate initial antibiotics (odds ratio = 3.6, P = 0.02). There were no deaths in the Pseudomonas bacteraemia group, whereas 19% died in the non- Pseudomonas group. The TCC was removed in 89% of Pseudomonas bacteraemias. There were no significant risk factors for acquiring a Pseudomonas isolate, and no difference in recurrent bacteraemia or infectious complication rates between the groups. Conclusions. In haemodialysis patients with a TCC-associated Pseudomonas bacteraemia, outcomes are remarkably good. This may be because the source of Pseudomonas infection was removed in most cases. Initial antibiotic coverage lacking anti- Pseudomonas activity was not associated with increased mortality.

Original languageEnglish (US)
Pages (from-to)1328-1333
Number of pages6
JournalNephrology Dialysis Transplantation
Volume21
Issue number5
DOIs
StatePublished - May 2006

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Bacteremia
Pseudomonas
Renal Dialysis
Catheters
Mortality
Anti-Bacterial Agents
Pseudomonas Infections
Observational Studies
Sepsis
Outpatients

Keywords

  • Bacteraemia
  • Catheter
  • Gram negative bacilli
  • Haemodialysis
  • Pseudomonas

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

@article{1be09181b57844e089de4eb89a42c559,
title = "Favourable outcomes in episodes of Pseudomonas bacteraemia when associated with tunnelled cuffed catheters (TCCs) in chronic haemodialysis patients",
abstract = "Background. Pseudomonas is regarded as a particularly lethal bacterial isolate. High mortality rates have been reported in episodes of Pseudomonas sepsis when associated with visceral infections as seen in immunosuppressed, hospitalized patients. In comparison, lower mortality rates have been reported with catheter-associated Pseudomonas bacteraemia in non-dialysis patients. The purpose of this study was to determine the risk factors and the outcomes for episodes of Pseudomonas bacteraemia associated with the use of tunnelled cuffed haemodialysis catheters (TCCs) in a chronic out-patient population. Methods. We performed a prospective observational study in seven chronic haemodialysis units over a 2.5 year period. Patients who were diagnosed as having their initial TCC-associated bacteraemia within the study period were followed for 3 months. All episodes of Pseudomonas TCC bacteraemia were identified, and univariate analyses were performed to compare Pseudomonas bacteraemia with non- Pseudomonas bacteraemia. Results. During the study period, 219 episodes of TCC bacteraemia were identified; 18 had a Pseudomonas isolate (8{\%}). Pseudomonas bacteraemia episodes were associated with a significantly higher risk of not receiving appropriate initial antibiotics (odds ratio = 3.6, P = 0.02). There were no deaths in the Pseudomonas bacteraemia group, whereas 19{\%} died in the non- Pseudomonas group. The TCC was removed in 89{\%} of Pseudomonas bacteraemias. There were no significant risk factors for acquiring a Pseudomonas isolate, and no difference in recurrent bacteraemia or infectious complication rates between the groups. Conclusions. In haemodialysis patients with a TCC-associated Pseudomonas bacteraemia, outcomes are remarkably good. This may be because the source of Pseudomonas infection was removed in most cases. Initial antibiotic coverage lacking anti- Pseudomonas activity was not associated with increased mortality.",
keywords = "Bacteraemia, Catheter, Gram negative bacilli, Haemodialysis, Pseudomonas",
author = "Ladan Golestaneh and Jeffrey Laut and Rosenberg, {Stuart O.} and Meilin Zhang and Mokrzycki, {Michele H.}",
year = "2006",
month = "5",
doi = "10.1093/ndt/gfk078",
language = "English (US)",
volume = "21",
pages = "1328--1333",
journal = "Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "5",

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TY - JOUR

T1 - Favourable outcomes in episodes of Pseudomonas bacteraemia when associated with tunnelled cuffed catheters (TCCs) in chronic haemodialysis patients

AU - Golestaneh, Ladan

AU - Laut, Jeffrey

AU - Rosenberg, Stuart O.

AU - Zhang, Meilin

AU - Mokrzycki, Michele H.

PY - 2006/5

Y1 - 2006/5

N2 - Background. Pseudomonas is regarded as a particularly lethal bacterial isolate. High mortality rates have been reported in episodes of Pseudomonas sepsis when associated with visceral infections as seen in immunosuppressed, hospitalized patients. In comparison, lower mortality rates have been reported with catheter-associated Pseudomonas bacteraemia in non-dialysis patients. The purpose of this study was to determine the risk factors and the outcomes for episodes of Pseudomonas bacteraemia associated with the use of tunnelled cuffed haemodialysis catheters (TCCs) in a chronic out-patient population. Methods. We performed a prospective observational study in seven chronic haemodialysis units over a 2.5 year period. Patients who were diagnosed as having their initial TCC-associated bacteraemia within the study period were followed for 3 months. All episodes of Pseudomonas TCC bacteraemia were identified, and univariate analyses were performed to compare Pseudomonas bacteraemia with non- Pseudomonas bacteraemia. Results. During the study period, 219 episodes of TCC bacteraemia were identified; 18 had a Pseudomonas isolate (8%). Pseudomonas bacteraemia episodes were associated with a significantly higher risk of not receiving appropriate initial antibiotics (odds ratio = 3.6, P = 0.02). There were no deaths in the Pseudomonas bacteraemia group, whereas 19% died in the non- Pseudomonas group. The TCC was removed in 89% of Pseudomonas bacteraemias. There were no significant risk factors for acquiring a Pseudomonas isolate, and no difference in recurrent bacteraemia or infectious complication rates between the groups. Conclusions. In haemodialysis patients with a TCC-associated Pseudomonas bacteraemia, outcomes are remarkably good. This may be because the source of Pseudomonas infection was removed in most cases. Initial antibiotic coverage lacking anti- Pseudomonas activity was not associated with increased mortality.

AB - Background. Pseudomonas is regarded as a particularly lethal bacterial isolate. High mortality rates have been reported in episodes of Pseudomonas sepsis when associated with visceral infections as seen in immunosuppressed, hospitalized patients. In comparison, lower mortality rates have been reported with catheter-associated Pseudomonas bacteraemia in non-dialysis patients. The purpose of this study was to determine the risk factors and the outcomes for episodes of Pseudomonas bacteraemia associated with the use of tunnelled cuffed haemodialysis catheters (TCCs) in a chronic out-patient population. Methods. We performed a prospective observational study in seven chronic haemodialysis units over a 2.5 year period. Patients who were diagnosed as having their initial TCC-associated bacteraemia within the study period were followed for 3 months. All episodes of Pseudomonas TCC bacteraemia were identified, and univariate analyses were performed to compare Pseudomonas bacteraemia with non- Pseudomonas bacteraemia. Results. During the study period, 219 episodes of TCC bacteraemia were identified; 18 had a Pseudomonas isolate (8%). Pseudomonas bacteraemia episodes were associated with a significantly higher risk of not receiving appropriate initial antibiotics (odds ratio = 3.6, P = 0.02). There were no deaths in the Pseudomonas bacteraemia group, whereas 19% died in the non- Pseudomonas group. The TCC was removed in 89% of Pseudomonas bacteraemias. There were no significant risk factors for acquiring a Pseudomonas isolate, and no difference in recurrent bacteraemia or infectious complication rates between the groups. Conclusions. In haemodialysis patients with a TCC-associated Pseudomonas bacteraemia, outcomes are remarkably good. This may be because the source of Pseudomonas infection was removed in most cases. Initial antibiotic coverage lacking anti- Pseudomonas activity was not associated with increased mortality.

KW - Bacteraemia

KW - Catheter

KW - Gram negative bacilli

KW - Haemodialysis

KW - Pseudomonas

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U2 - 10.1093/ndt/gfk078

DO - 10.1093/ndt/gfk078

M3 - Article

C2 - 16421157

AN - SCOPUS:33646165981

VL - 21

SP - 1328

EP - 1333

JO - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

SN - 0931-0509

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