ORIGINAL ARTICLES   

Minerva Urologica e Nefrologica 1998 September;50(3):179-83

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Infection from extemporary catheters for hemodialysis. The experience of a centre

Ottone S. ¹, Cecere P. ¹, Colombo P. ¹, Porcu M. ¹, Filiberti O. ¹, Costantini L. ¹, Guazzotti G. C. ², Cagna G. ¹, Peona C. ¹

¹ Azienda Regionale USL 11, Ospedale Sant’Andrea - Vercelli, Servizio di Nefrologia e Dialisi; ² Azienda Regionale USL 11, Ospedale Sant’Andrea - Vercelli, Servizio di Microbiologia

Background and aims. This study reports a retrospective evaluation of the predominance of infection in 67 dual lumen central venous catheters (CVC), 35 of which were positioned in the femoral vein by the nephrological team and 32 in the subclavian vein by anesthetists.
Methods. The microrganisms responsible for infection, the prevalence of clinically symptomatic infections, the relationship between CVC-correlated infection and the time the catheter remained inserted were evaluated, together with a comparision between the two different insertion sites.
Results. Culture tests, performed using Maki’s semiquantitative technique, gave positive results in 16/67 (23.8%) cases. The main pathogenic agents found were Staphylococcus epidermidis (37.5%) and Staphylococcus aureus (31.2%). In 3/16 cases (18.78%) infections were clinically symptomatic. The mean permanence of CVC with positive cultures was not statistically different to the mean permanence of CVC with negative cultures (22.44±13.48 vs 18.38±17.76). The microrganisms isolated on femoral and subclavian catheters showed a comparable distribution and the prevalence of infection was not statistically different in the two insertion sites.
Conclusions. In conclusion, in the absence of infection, the authors tend to keep working catheters in the site, thus avoiding repeated invasive manoeuvres for replacement and/or repositioning, whereas in the presence of suspected systemic infection they feel it is more prudent to remove the CVC without waiting for the results of the hemoculture, starting first empiric and then specific antibiotic treatment on the basis of the antibiogram.