Current aspects in the diagnosis and management of catheter-related sepsis, observed in patients undergoing hemodialysis with a tunneled catheter
DOI:
https://doi.org/10.2478/amb-2024-0045Keywords:
hemodialysis, tunneled catheter, catheter-related bloodstream infection, catheter-related sepsis, diagnosis and managementAbstract
Tunnelled catheters have become established as a common vascular access in the last few decades. Besides the convenience associated with their use, we also reap the bitter fruits of their complications. Catheter-associated infections are part of daily life
in dialysis units and we must know them well – early diagnosis, adequate behaviour and prevention. The aim of this short review is to highlight some modern aspects of diagnosis and treatment of catheter-associated infections, while also sharing our modest experience.
References
Neuen BL, Chadban SJ, Demaio AR et al. Chronic kidney disease and the global NCDs agenda. BMJ Glob Health. 2017 Jul 6;2(2):e000380.
Jager KJ, Kovesdy C, Langham R. et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019 Nov; 96(5):1048-1050.
Bello AK, Okpechi IG, Osman MA, et al. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022; 18(6):378-395. 74 B. Borisov, D. Borisov
United States Renal Data System. 2020 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. (National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2020).
Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. Am J Kidney Dis. 2015 Jan; 65(1):98-108
Htay H, Bello AK, Levin A. et al. Hemodialysis Use and Practice Patterns: An International Survey Study. Am J Kidney Dis. 2021 Mar; 77(3):326-335.e1.
Gahlot R, Nigam C, Kumar V. et al. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014 Apr; 4(2):162-7.
Silva TN, Mendes ML, Abrao JM. et al. Successful prevention
of tunneled central catheter infection by antibiotic lock therapy using cefazolin and gentamicin. Int Urol Nephrol. 2013;
(5):1405-1413.
Martin K, Lorenzo YSP, Leung PYM. et al. Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections. Open Forum Infect Dis. 2020 Apr 11; 7(6):ofaa117.
Lata C, Girard L, Parkins M, James MT. Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review. Can J Kidney Health Dis. 2016; 3:24.
Schönenberger M, Forster C, Siegemund, M. et al. Catheter related blood stream infections in critically ill patients with continuous haemo (dia) filtration and temporary nontunnelled vascular access. Swiss Med Wkly. 2011; 141:47-48.
Christensen GD, Simpson WA, Bisno AL, Beachey EH. Adherence of slime-producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun 1982; 37(1):318–326.
Treter, J, Macedo A. Catheters: A suitable surface for biofilm formation. Sci Microb Pathog Commun Curr Res Technol Adv. 2011; 835-842.
Allon M. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004; 44(5):779–791.
Gahlot R, Nigam C, Kumar V, et al. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014; 4(2):162-167.
Mitchell E, Pearce MS, Roberts A. Gram-negative bloodstream infections and sepsis: risk factors, screening tools and surveillance. Br Med Bull. 2019 Dec 11; 132(1):5-15.
Liu HH, Zhang MW, Guo JB. et al. Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either Gram-negative or Gram-positive bacteria. Ir J Med Sci. 2017; 186(1): 207-212.
Ramachandran G. Gram-positive and gram-negative bacterial toxins in sepsis: a brief review. Virulence. 2014; 5(1): 213-218.
Fan SL, Miller NS, Lee J, Remick DG. Diagnosing sepsis. The role of laboratory medicine. Clin Chim Acta. 2016; 460:203-210.
Le Moullec JM, Jullienne A, Chenais J, et al. The complete sequence of human preprocalcitonin. FEBS Lett. 1984; 167(1): 93-97.
Assicot M, Gendrel D, Carsin H, et al. C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993; 341(8844): 515-518.
Lippi G, Sanchis-Gomar F. Procalcitonin in inflammatory bowel disease: Drawbacks and opportunities. World J Gastroenterol. 2017; 23(47): 8283-8290.
Kip MMA, van Oers JA, Shajiei A et al. Cost-effectiveness of procalcitonin testing to guide antibiotic treatment duration in critically ill patients: results from a randomised controlled multicentre trial in the Netherlands. Crit Care. 2018; 22(1): 293.
Jungen MJ, Ter Meulen BC, van Osch T, et al. Inflammatory biomarkers in patients with sciatica: a systematic review. BMC Musculoskelet Disord. 2019; 20(1): 156.
Li J, Hu L, Li L. C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis. Emerg Med Int. 2022; 2022:2498435.
Carrigan SD, Scott G, Tabrizian M. Toward resolving the challenges of sepsis diagnosis. Clin Chem. 2004; 50:1301–1314.
Abe R, Oda S, Sadahiro T, et al. Gram-negative bacteremia induces greater magnitude of inflammatory response than Gram-positive bacteremia. Crit Care. 2010;14(2): R27.
Surbatovic M, Popovic N, Vojvodic D, et al. Cytokine profile in severe Gram-positive and Gram-negative abdominal sepsis. Sci Rep. 2015; 5:11355. doi: 10.1038/srep11355.
Liu Z, Meng Z, Li Y, et al. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis. Scand J Trauma Resusc Emerg Med. 2019 Apr 30; 27(1):51.
Marikar D, Babu P, Fine-Goulden M. How to interpret lactate Archives of Disease in Childhood - Education and Practice
; 106:167-171.
Timsit JF, Baleine J, Bernard L, et al. Expert consensusbased clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care. 2020;10(1):118.
Snyder SR, Favoretto AM, Baetz RA, et al. Effectiveness of practices to reduce blood culture contamination: A Laboratory
Medicine Best Practices systematic review and meta-analysis. Clin Biochem. 2012; 45(13-14):999-1011.
Wilson ML, Clinical and Laboratory Standards Institute. M47. Principles and Procedures for Blood Cultures. 2nd Edition. 2022, 110.
Gunvanti R, Lakshmi JT, Ariyanachi K, et al. Blood Culture Contamination Rate as a Quality Indicator - a Prospective Observational Study. Maedica (Bucur). 2022; 17(2):311-316.
Quittnat PF, Joarder M, Poutanen SM, Lok CE. Evaluating Approaches for the Diagnosis of Hemodialysis Catheter-Related Bloodstream Infections. Clin J Am Soc Nephrol. 2016; 11(5):847-854.
Riedel S, Bourbeau P, Swartz B, et al. Timing of specimen collection for blood cultures from febrile patients with bacteremia. J Clin Microbiol. 2008; 46(4):1381-5.
Bennet IL Jr, Beeson PB. Bacteremia: a consideration of some experimental and clinical aspects. Yale J Biol Med. 1954; 26(4):241-262.
Taniguchi T, Tsuha S, Shiiki S, Narita M. High positivity of blood cultures obtained within two hours after shaking chills. Int J Infect Dis. 2018; 76:23-28.
Holmqvist M, Inghammar M, Påhlman LI, et al. Risk of bacteremia in patients presenting with shaking chills and vomiting – a prospective cohort study. Epidemiol Infect. 2020; 148:e86.
Lok CE, Huber TS, Lee T, et al. National Kidney Foundation. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4Suppl2): S1-S164.
Borisov B, Linkova S. Infectious Complications of Hemodialysis Tunneled Catheters—Types, Diagnosis, and Treatment Strategies. Indian J Surg 2020; 82, 460–464.
Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int. 2011;79(6):587-598.
Mermel LA, M. Allon, E. Bouza et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 49(1): 1-45.
Beathhard G. Management of Bacteremia Associated with Tunneled-Cuffed Hemodialysis Catheters. J Am Soc Nephrol. 1999; 10: 1045-1049.
Hajji M, Neji M, Agrebi S, et al. Incidence and challenges in management of hemodialysis catheter-related infections. Sci Rep. 022;12(1):20536.
Miller LM, Clark E, Dipchand C, et al. Canadian Society of Nephrology Vascular Access Work Group. Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis. 2016; 3:2054358116669129.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 B. Borisov, D. Borisov (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
You are free to share, copy and redistribute the material in any medium or format under these terms.
Journal Acta Medica Bulgarica 
