Journal Article

Cause and outcome of central venous catheter infections in paediatric haemodialysis patients

Douglas M. Silverstein and Kathleen Moylan

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 10, pages 3332-3337
Published in print October 2010 | ISSN: 0931-0509
Published online March 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq146
Cause and outcome of central venous catheter infections in paediatric haemodialysis patients

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Background. Paediatric patients with end-stage renal disease often receive haemodialysis (HD) via a central venous catheter (CVC). The most common problem with CVC is infection.

Methods. We assessed infection rates and subsequent outcome in paediatric chronic HD patients receiving dialysis via a CVC.

Results. Over a 3-year period, there were 28 episodes of infection in 17 patients. The overall rate of infection was 13.7 infections/100 catheter months. Among all catheters, catheter survival was 4.5 ± 0.8 months and similar in infected versus uninfected catheters. Among the 28 infections, there were 43 organisms captured. The most common organisms were Gram-positive, comprising 79% of all species. Among Gram-positive organisms, all coagulase-negative and -positive organisms were sensitive to vancomycin while all enterococci were sensitive to vancomycin. The majority of Gram-negative organisms were sensitive to aminoglycosides or cephalosporins. Among infected catheters, the rate of thrombosis was 1 event/1.7 catheter months; in uninfected catheters, the overall prevalence and rate of thrombosis was similar (1 event/1.6 catheter months). Thirty-nine percent of infections resulted in catheter loss within the subsequent 2 months, the most common reason being catheter occlusion. Multiple organisms/episode were more common in patients who required catheter replacement (46%) than in those who had salvage of the catheter (25%).

Conclusions. In summary, HD catheter infection rates are high, while thrombosis rates are similar in infected and uninfected catheters. Infection with Gram-positive organisms was most common. The vast majority of CVC infections are cleared by antibiotics, although catheter loss is not uncommon even after clearance of the organism.

Keywords: central venous catheter; haemodialysis; infection; paediatric

Journal Article.  3409 words. 

Subjects: Nephrology

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