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Staphylococcus-Infected Tunneled Dialysis Catheters: Is Over-the-Wire Exchange an Appropriate Management Option?

  • Clinical Investigation
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Abstract

Purpose

Over-the-wire exchange of tunneled dialysis catheters is the standard of care per K/DOQI guidelines for treating catheter-related bacteremia. However, Gram-positive bacteremia, specifically with staphylococcus species, may compromise over-the-wire exchange due to certain biological properties. This study addressed the effectiveness of over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters compared with non-staphylococcus-infected tunneled dialysis catheters.

Methods

Patients who received over-the-wire exchange of their tunneled dialysis catheter due to documented or suspected bacteremia were identified from a QA database. Study patients (n = 61) had positive cultures for Staphylococcus aureus, Staphylococcus epidermidis, or coagulase-negative staphylococcus not otherwise specified. Control patients (n = 35) received over-the-wire exchange of their tunneled dialysis catheter due to infection with any organism besides staphylococcus. Overall catheter survival and catheter survival among staphylococcal species were assessed.

Results

There was no difference in tunneled dialysis catheter survival between study and control groups (P = 0.46). Median survival time was 96 days for study catheters and 51 days for controls; survival curves were closely superimposed. There also was no difference among the three staphylococcal groups in terms of catheter survival (P = 0.31). The median time until catheter removal was 143 days for SE, 67 days for CNS, and 88 days for SA-infected catheters.

Conclusions

There is no significant difference in tunneled dialysis catheter survival between over-the-wire exchange of staphylococcus-infected tunneled dialysis catheters and those infected with other organisms.

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Acknowledgement

Supported in part by: NIDDK, 2008, T35 DK 060441-06 NIDDK Short Term Experience in Research Grant.

Conflict of interest

Dr. Trerotola is a consultant for MedComp, Bard, Arrow, and Cook. None of the other authors has a conflict to disclose.

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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA, 19104, USA

    Jessica M. Langer, Emily T. Cooper & Scott O. Trerotola

  2. Department of Medicine, Renal, Electrolyte and Hypertension Division, University of Pennsylvania Medical Center, Philadelphia, PA, USA

    Raphael M. Cohen & Jeffrey S. Berns

  3. Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA

    Jesse Chittams

  4. Department of Vascular and Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Scott O. Trerotola

Authors
  1. Jessica M. Langer
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  2. Raphael M. Cohen
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  3. Jeffrey S. Berns
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  4. Jesse Chittams
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  5. Emily T. Cooper
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  6. Scott O. Trerotola
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Corresponding author

Correspondence to Scott O. Trerotola.

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Langer, J.M., Cohen, R.M., Berns, J.S. et al. Staphylococcus-Infected Tunneled Dialysis Catheters: Is Over-the-Wire Exchange an Appropriate Management Option?. Cardiovasc Intervent Radiol 34, 1230–1235 (2011). https://doi.org/10.1007/s00270-011-0180-4

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  • DOI: https://doi.org/10.1007/s00270-011-0180-4

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