Prophylactic Antibiotics Before Insertion of Tunneled Hemodialysis Catheters: A Nationwide Cohort Study.

Abstract

Rationale & objective: It is unknown whether administration of prophylactic systemic antibiotics immediately before tunneled catheter insertion can prevent early hemodialysis catheter-related bloodstream infections (HDCRBSI). We aimed to estimate the effect of systemic prophylactic antibiotics on early HDCRBSI.

Study design: An observational secondary analysis using data from the nationwide REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach trial.

Setting & participants: Adults with an incident hemodialysis catheter inserted in one of 37 Australian nephrology services from December 2016 to March 2020.

Exposure: Service-wide policy of systemic prophylactic antibiotic use before tunneled catheter insertion determined by response to a prestudy survey.

Outcome: HDCRBSI within 14 days of catheter insertion, independently adjudicated by a blinded panel using modified Infectious Diseases Society of America criteria.

Analytical approach: Multilevel logistic regression to compare outcomes among antibiotic-using and nonusing services.

Results: Six services (900 patients) used prophylactic antibiotics, and 23 services (3,702 patients) did not. Among the 1,196 tunneled catheters that were inserted in antibiotic-using services, 4 (0.3%) had HDCRBSI and another 10 (0.8%) had infectious removal within 14 days of insertion. Among the 5,027 tunneled catheters inserted in nonantibiotic-using services, 40 (0.8%) had HDCRBSI and another 41 (0.8%) had infectious removal within 14 days. The odds of early HDCRBSI were not significantly different between antibiotic-using and nonusing services in the unadjusted (OR, 0.42; 95% CI, 0.15-1.17) or adjusted models (adjusted OR, 0.59; 95% CI, 0.20-1.80).

Limitations: Prophylactic systemic antibiotic use was determined at a service level and was not randomly assigned to individuals.

Conclusions: In Australia, less than 1% of tunneled catheters had confirmed HDCRBSI within 14 days of insertion. Routine administration of prophylactic antibiotics before insertion of tunneled cuffed catheters was not associated with a reduced occurrence of early HDCRBSI within 14 days.