Catheter-related bloodstream infection in patients with non-cuffed hemodialysis catheters and the importance of anti-MRSA agents for empirical therapy

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Catheter-related bloodstream infection (CRBSI) is the most critical complication in patients with hemodialysis catheters. To investigate agendas and therapeutic strategies, we examined 254 patients who had received non-cuffed hemodialysis catheters at our hospital between April 2006 and March 2009. We assessed 14 patients who developed CRBSI; the incidence of CRBSI was 4.6 episodes per 1,000 catheter days. Of these CRBSI patients, 79% (11/14) had internal jugular vein catheters, and the average duration of catheterization before the occurrence of CRBSI was 11.8±8.1 days. Gram-positive cocci were discovered in 79% (11/14) of CRBSI cases, and <I>Staphylococcus aureus</I> was the most common species. The pathogenic bacteria were drug-resistant, with 57% (8/14) sensitive to anti-MRSA agents only. Mortality after 30 days was 14% (1/7) for patients treated with and 57% (4/7) for those not treated with anti-MRSA agents (p=0.078). The rate of pyretolysis within 72 h was 86% (6/7) for patients treated with and 14% (1/7) for those not treated with anti-MRSA agents (p=0.0291). There were two cases of septic shock, one case of suppurative thrombophlebitis, and one case of liver abscess as metastatic infectious complications for patients not treated with anti-MRSA agents. This surveillance study demonstrated that drug-resistant Gram-positive cocci, including MRSA, are common in CRBSI, and we therefore conclude that it is important to diagnose CRBSI early and start empirical therapy that includes anti-MRSA agents.

Catheter-related bloodstream infection in patients with non-cuffed hemodialysis catheters and the importance of anti-MRSA agents for empirical therapy

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