Tunnelled haemodialysis catheter bacteraemia: Risk factors for bacteraemia recurrence, infectious complications and mortality

Michele H. Mokrzycki, Meilin Zhang, Hillel Cohen, Ladan Golestaneh, Jeffrey M. Laut, Stuart O. Rosenberg

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Background. Infection is a serious complication of tunnelled cuffed catheter (TCC) use and is associated with high complication and mortality rates. Although attempts at TCC salvage after bacteraemia have been associated with high rates of recurrent bacteraemia, there have been no large studies in which multivariate analysis has been performed to control for confounding factors such as infecting organisms, diabetes, etc. Methods. A prospective observational study was performed in chronic HD patients dialyzing with a TCC at seven outpatient HD centers. All patients diagnosed with TCC bacteraemia were observed for 3 months following initial presentation and outcomes were recorded. Results. Dur ing the 2.5 year study period, 226 patients had an episode of TCC bacteraemia that met inclusion criteria, and 3 month follow-up data were available in 219 episodes. Treatment failure, defined as recurrent TCC bacteraemia with the same organism or death from sepsis, occurred in 26 patients (12%). Infectious complications (such as endocarditis, osteomyelitis, etc.) occurred in 16 patients (7%), bacteraemia with a different organism occurred in 19 patients (9%), and death from sepsis occurred in eight patients (4%). Significant predictors of treatment failure (by univariate analysis) were TCC salvage, and infection with Staphylococcus aureus (OR = 4.2, P = 0.002; and OR = 3.3, P = 0.02, respectively). TCC salvage, when used in episodes of S. aureus bacteraemia, was associated with an 8-fold higher risk of treatment failure (P = 0.001). The presence of an abnormal TCC exit site was associated with a significantly higher rate of death from sepsis, (OR = 7, P = 0.001). Outcomes (treatment failure and infectious complications) did not differ among bacteraemic episodes where the TCC was exchanged over a guidewire compared to those in which the TCC was immediately removed followed by delayed reinsertion. In the multivariate analysis, adjusted for potential confounding covariates, the only significant predictors of treatment failure after an episode of TCC bacteraemia were TCC salvage (OR = 5.4, P = 0.003), and S. aureus(OR = 4.2, P = 0.002). In a multivariate analysis, controlling for TCC management, the only variable that was significantly associated with the development of an infectious complication was infection with S. aureus (OR = 3.5, P = 0.02) Conclusions. We have shown, using multivariate analysis and adjusting for potential confounding factors, that the use of TCC salvage and S. aureus are independent risk factors for treatment failure after an episode of TCC bacteraemia, and that S. aureus is an independent risk factor for developing an infectious complication. An infected-appearing TCC exit site is associated with a higher mortality rate. Episodes of TCC bacteraemia treated using TCC salvage are associated with the highest treatment failure rates. TCC guidewire exchange can be an acceptable practice, unless severe exit site or tunnel infection is present.

Original languageEnglish (US)
Pages (from-to)1024-1031
Number of pages8
JournalNephrology Dialysis Transplantation
Volume21
Issue number4
DOIs
StatePublished - Apr 2006

Fingerprint

Bacteremia
Renal Dialysis
Catheters
Recurrence
Mortality
Treatment Failure
Staphylococcus aureus
Multivariate Analysis
Sepsis
Infection
Osteomyelitis

Keywords

  • Bacteraemia
  • Catheter
  • Haemodialysis
  • Sepsis
  • Tunnelled catheter

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

@article{f815ea85e69e4af5a8c90b7138d9d5d5,
title = "Tunnelled haemodialysis catheter bacteraemia: Risk factors for bacteraemia recurrence, infectious complications and mortality",
abstract = "Background. Infection is a serious complication of tunnelled cuffed catheter (TCC) use and is associated with high complication and mortality rates. Although attempts at TCC salvage after bacteraemia have been associated with high rates of recurrent bacteraemia, there have been no large studies in which multivariate analysis has been performed to control for confounding factors such as infecting organisms, diabetes, etc. Methods. A prospective observational study was performed in chronic HD patients dialyzing with a TCC at seven outpatient HD centers. All patients diagnosed with TCC bacteraemia were observed for 3 months following initial presentation and outcomes were recorded. Results. Dur ing the 2.5 year study period, 226 patients had an episode of TCC bacteraemia that met inclusion criteria, and 3 month follow-up data were available in 219 episodes. Treatment failure, defined as recurrent TCC bacteraemia with the same organism or death from sepsis, occurred in 26 patients (12{\%}). Infectious complications (such as endocarditis, osteomyelitis, etc.) occurred in 16 patients (7{\%}), bacteraemia with a different organism occurred in 19 patients (9{\%}), and death from sepsis occurred in eight patients (4{\%}). Significant predictors of treatment failure (by univariate analysis) were TCC salvage, and infection with Staphylococcus aureus (OR = 4.2, P = 0.002; and OR = 3.3, P = 0.02, respectively). TCC salvage, when used in episodes of S. aureus bacteraemia, was associated with an 8-fold higher risk of treatment failure (P = 0.001). The presence of an abnormal TCC exit site was associated with a significantly higher rate of death from sepsis, (OR = 7, P = 0.001). Outcomes (treatment failure and infectious complications) did not differ among bacteraemic episodes where the TCC was exchanged over a guidewire compared to those in which the TCC was immediately removed followed by delayed reinsertion. In the multivariate analysis, adjusted for potential confounding covariates, the only significant predictors of treatment failure after an episode of TCC bacteraemia were TCC salvage (OR = 5.4, P = 0.003), and S. aureus(OR = 4.2, P = 0.002). In a multivariate analysis, controlling for TCC management, the only variable that was significantly associated with the development of an infectious complication was infection with S. aureus (OR = 3.5, P = 0.02) Conclusions. We have shown, using multivariate analysis and adjusting for potential confounding factors, that the use of TCC salvage and S. aureus are independent risk factors for treatment failure after an episode of TCC bacteraemia, and that S. aureus is an independent risk factor for developing an infectious complication. An infected-appearing TCC exit site is associated with a higher mortality rate. Episodes of TCC bacteraemia treated using TCC salvage are associated with the highest treatment failure rates. TCC guidewire exchange can be an acceptable practice, unless severe exit site or tunnel infection is present.",
keywords = "Bacteraemia, Catheter, Haemodialysis, Sepsis, Tunnelled catheter",
author = "Mokrzycki, {Michele H.} and Meilin Zhang and Hillel Cohen and Ladan Golestaneh and Laut, {Jeffrey M.} and Rosenberg, {Stuart O.}",
year = "2006",
month = "4",
doi = "10.1093/ndt/gfi104",
language = "English (US)",
volume = "21",
pages = "1024--1031",
journal = "Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Tunnelled haemodialysis catheter bacteraemia

T2 - Risk factors for bacteraemia recurrence, infectious complications and mortality

AU - Mokrzycki, Michele H.

AU - Zhang, Meilin

AU - Cohen, Hillel

AU - Golestaneh, Ladan

AU - Laut, Jeffrey M.

AU - Rosenberg, Stuart O.

PY - 2006/4

Y1 - 2006/4

N2 - Background. Infection is a serious complication of tunnelled cuffed catheter (TCC) use and is associated with high complication and mortality rates. Although attempts at TCC salvage after bacteraemia have been associated with high rates of recurrent bacteraemia, there have been no large studies in which multivariate analysis has been performed to control for confounding factors such as infecting organisms, diabetes, etc. Methods. A prospective observational study was performed in chronic HD patients dialyzing with a TCC at seven outpatient HD centers. All patients diagnosed with TCC bacteraemia were observed for 3 months following initial presentation and outcomes were recorded. Results. Dur ing the 2.5 year study period, 226 patients had an episode of TCC bacteraemia that met inclusion criteria, and 3 month follow-up data were available in 219 episodes. Treatment failure, defined as recurrent TCC bacteraemia with the same organism or death from sepsis, occurred in 26 patients (12%). Infectious complications (such as endocarditis, osteomyelitis, etc.) occurred in 16 patients (7%), bacteraemia with a different organism occurred in 19 patients (9%), and death from sepsis occurred in eight patients (4%). Significant predictors of treatment failure (by univariate analysis) were TCC salvage, and infection with Staphylococcus aureus (OR = 4.2, P = 0.002; and OR = 3.3, P = 0.02, respectively). TCC salvage, when used in episodes of S. aureus bacteraemia, was associated with an 8-fold higher risk of treatment failure (P = 0.001). The presence of an abnormal TCC exit site was associated with a significantly higher rate of death from sepsis, (OR = 7, P = 0.001). Outcomes (treatment failure and infectious complications) did not differ among bacteraemic episodes where the TCC was exchanged over a guidewire compared to those in which the TCC was immediately removed followed by delayed reinsertion. In the multivariate analysis, adjusted for potential confounding covariates, the only significant predictors of treatment failure after an episode of TCC bacteraemia were TCC salvage (OR = 5.4, P = 0.003), and S. aureus(OR = 4.2, P = 0.002). In a multivariate analysis, controlling for TCC management, the only variable that was significantly associated with the development of an infectious complication was infection with S. aureus (OR = 3.5, P = 0.02) Conclusions. We have shown, using multivariate analysis and adjusting for potential confounding factors, that the use of TCC salvage and S. aureus are independent risk factors for treatment failure after an episode of TCC bacteraemia, and that S. aureus is an independent risk factor for developing an infectious complication. An infected-appearing TCC exit site is associated with a higher mortality rate. Episodes of TCC bacteraemia treated using TCC salvage are associated with the highest treatment failure rates. TCC guidewire exchange can be an acceptable practice, unless severe exit site or tunnel infection is present.

AB - Background. Infection is a serious complication of tunnelled cuffed catheter (TCC) use and is associated with high complication and mortality rates. Although attempts at TCC salvage after bacteraemia have been associated with high rates of recurrent bacteraemia, there have been no large studies in which multivariate analysis has been performed to control for confounding factors such as infecting organisms, diabetes, etc. Methods. A prospective observational study was performed in chronic HD patients dialyzing with a TCC at seven outpatient HD centers. All patients diagnosed with TCC bacteraemia were observed for 3 months following initial presentation and outcomes were recorded. Results. Dur ing the 2.5 year study period, 226 patients had an episode of TCC bacteraemia that met inclusion criteria, and 3 month follow-up data were available in 219 episodes. Treatment failure, defined as recurrent TCC bacteraemia with the same organism or death from sepsis, occurred in 26 patients (12%). Infectious complications (such as endocarditis, osteomyelitis, etc.) occurred in 16 patients (7%), bacteraemia with a different organism occurred in 19 patients (9%), and death from sepsis occurred in eight patients (4%). Significant predictors of treatment failure (by univariate analysis) were TCC salvage, and infection with Staphylococcus aureus (OR = 4.2, P = 0.002; and OR = 3.3, P = 0.02, respectively). TCC salvage, when used in episodes of S. aureus bacteraemia, was associated with an 8-fold higher risk of treatment failure (P = 0.001). The presence of an abnormal TCC exit site was associated with a significantly higher rate of death from sepsis, (OR = 7, P = 0.001). Outcomes (treatment failure and infectious complications) did not differ among bacteraemic episodes where the TCC was exchanged over a guidewire compared to those in which the TCC was immediately removed followed by delayed reinsertion. In the multivariate analysis, adjusted for potential confounding covariates, the only significant predictors of treatment failure after an episode of TCC bacteraemia were TCC salvage (OR = 5.4, P = 0.003), and S. aureus(OR = 4.2, P = 0.002). In a multivariate analysis, controlling for TCC management, the only variable that was significantly associated with the development of an infectious complication was infection with S. aureus (OR = 3.5, P = 0.02) Conclusions. We have shown, using multivariate analysis and adjusting for potential confounding factors, that the use of TCC salvage and S. aureus are independent risk factors for treatment failure after an episode of TCC bacteraemia, and that S. aureus is an independent risk factor for developing an infectious complication. An infected-appearing TCC exit site is associated with a higher mortality rate. Episodes of TCC bacteraemia treated using TCC salvage are associated with the highest treatment failure rates. TCC guidewire exchange can be an acceptable practice, unless severe exit site or tunnel infection is present.

KW - Bacteraemia

KW - Catheter

KW - Haemodialysis

KW - Sepsis

KW - Tunnelled catheter

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U2 - 10.1093/ndt/gfi104

DO - 10.1093/ndt/gfi104

M3 - Article

C2 - 16449293

AN - SCOPUS:33645302355

VL - 21

SP - 1024

EP - 1031

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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