BAL HARBOUR, FLA. — Catheter-related bacteremia affecting catheter survival occurs frequently in children on hemodialysis, results of a recent study suggest.
A review of the charts of 60 children who had chronic hemodialysis catheters at the University of Miami between 1999 and 2003 showed that 188 catheter infections occurred in these patients; 49 (82%) of the children developed catheter-related bacteremia, Ali Mirza Onder, M.D., and colleagues at the University of Miami reported in a poster presentation at the annual Masters of Pediatrics conference sponsored by the university.
Of the 188 catheter infections, 67% were gram-positive infections, 14% were gram-negative infections, and 19% were polymicrobial. Of the gram-positive infections, 78% were oxacillin resistant.
Of the gram-negative infections, 22% were tobramycin resistant.
And of the polymicrobial infections, 88% were oxacillin resistant, and 72% were tobramycin resistant, the investigators found.
The occurrence of two or more catheter infections in a patient in 1 year was associated with increased risk of multiple episodes of catheter- related bacteremia, they noted.
Catheter replacement occurred 118 times; 63% of the replacements were due to infection, with catheter malfunction and cuff extension accounting for the remaining cases. Of the 118 replacements, 81 were wire-guided exchanges, as opposed to replacements following removal.
Catheter survival was not significantly different between those who had replacements and those who had exchanges (267 days vs. 249 days).
Systemic antibiotic therapy was effective for clearing infections in 60% of cases.
Catheter-related bacteremia affecting catheter survival is an important problem among children on maintenance hemodialysis.
Given the frequency of oxacillin- and tobramycin-resistant organisms seen in this study, regional prevalence of such resistance should be considered when selecting initial empiric therapy for catheter- related bacteremia, the investigators concluded.
When feasible, permanent vascular access should be considered, they added.