Management of hemodialysis catheter-related bacteremia - a 10-year experience

Between January 1986 and December 1995, 18 episodes of bacteremia occurred in our pediatric patients undergoing chronic hemodialysis on an outpatient basis. Seven episodes were caused by coagulase-negative Staphylococcus, 6 by Staphylococcus aureus, 2 by Mycobacterium. and 1 each by Pseudomonas, Xanthomonas. and Enterococcus. In 6 cases, the catheter was retained with antimicrobial therapy alone, whereas 12 cases required removal of the catheter after some period of time. The subset of cases in which catheter removal was necessary included 2 cases of Mycobacterium fortuitum complex and 5 cases of Staphylococcus aureus. We found that Staphylococcus aureus bacteremia may be cleared with antibiotic therapy alone in a minority of cases (17%). In the 6 cases in which catheters were retained and infections cleared, the maximum length of time to sterilization of blood with appropriate antibiotics was 48 h.