Adverse Outcomes After Tunneled Dialysis Catheter-Related Bloodstream Infections-Too Dark at the End of This Tunnel?

IF 1.4 4区医学 Q3 UROLOGY & NEPHROLOGY

Seminars in Dialysis Pub Date : 2024-12-05 DOI:10.1111/sdi.13232

Niveditha Pandit, Namrata Rao, Majibullah Ansari, Abhilash Chandra, Sai Saran

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Abstract

Background: Tunneled dialysis catheters (TDCs) are preferred over temporary noncuffed catheters for access in patients on maintenance hemodialysis. The removal of TDC after catheter-related blood stream infections (CRBSIs) is often not practiced even when indicated, and the adverse outcomes after such salvage are presently unclear.

Aims and objectives: The study aimed to evaluate adverse outcomes after the first episode of definite or probable CRBSI. The composite adverse outcome was recorded as the presence of at least one of three adverse outcomes-death in the index hospital admission, occurrence of recurrent bacteremia, and death within 3 months.

Results: During the study period, the TDC CRBSI incidence rate was 6.9/1000 catheter days. Of the 110 study participants, majority were male (63%), with a median age of 35 years, belonging to rural (56%) and agrarian (39%) communities, and 66% were getting dialyzed at stand-alone dialysis units. Gram-negative infections predominated (64%), with 37% of isolates showing resistance to carbapenems. Catheter salvage was practiced in 80%, and immediate catheter removal was done only in the sickest of patients (in seven of eight with in-hospital mortality). Predictors of composite adverse outcomes included sites other than right internal jugular vein (OR 3.6) and resistance to β lactam-β lactamase inhibitors (OR 16.2). At a median follow-up of 7 months, all survivors at 3 months were alive and 46% had recurrent TDC CRBSIs.

Conclusion: Up to one-half of patients with end-stage kidney disease experienced composite adverse outcomes after the first episode of TDC CRBSI, with infection-related 3-month mortality of 15%.

Trial registration: Clinical trial number: CTRI/2023/10/058556.

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隧道式透析导管相关血流感染后的不良后果——隧道尽头太暗？

背景：对于维持性血液透析患者，隧道式透析导管（tdc）比临时非套管式透析导管更受欢迎。导管相关血流感染（crbsi）后TDC的移除通常不被实践，即使在指征时，这种挽救后的不良后果目前尚不清楚。目的和目的：本研究旨在评估明确或可能的CRBSI首次发作后的不良后果。复合不良结局被记录为至少存在三种不良结局中的一种——入院时死亡、复发菌血症的发生和3个月内死亡。结果：研究期间，TDC CRBSI发生率为6.9/1000导管天。在110名研究参与者中，大多数是男性（63%），年龄中位数为35岁，属于农村（56%）和农业（39%）社区，66%在独立透析单位进行透析。革兰氏阴性感染占主导地位（64%），其中37%的分离株对碳青霉烯类具有耐药性。80%的患者进行了导管抢救，仅在病情最严重的患者中（8例住院死亡率中有7例）立即拔除导管。复合不良结局的预测因子包括右颈内静脉以外的部位（OR 3.6）和对β内酰胺-β内酰胺酶抑制剂的耐药性（OR 16.2）。在中位随访7个月时，所有幸存者在3个月时存活，46%有复发性TDC crbsi。结论：多达一半的终末期肾病患者在TDC CRBSI首次发作后出现复合不良结局，感染相关的3个月死亡率为15%。试验注册：临床试验编号：CTRI/2023/10/058556。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in Dialysis 医学-泌尿学与肾脏学

CiteScore

3.00

自引率

6.20%

发文量

审稿时长

4-8 weeks

期刊介绍： Seminars in Dialysis is a bimonthly publication focusing exclusively on cutting-edge clinical aspects of dialysis therapy. Besides publishing papers by the most respected names in the field of dialysis, the Journal has unique useful features, all designed to keep you current: -Fellows Forum -Dialysis rounds -Editorials -Opinions -Briefly noted -Summary and Comment -Guest Edited Issues -Special Articles Virtually everything you read in Seminars in Dialysis is written or solicited by the editors after choosing the most effective of nine different editorial styles and formats. They know that facts, speculations, ''how-to-do-it'' information, opinions, and news reports all play important roles in your education and the patient care you provide. Alternate issues of the journal are guest edited and focus on a single clinical topic in dialysis.