From the Guidelines
Permicath removal is indicated in ESRD patients with catheter-related infections when there is tunnel infection, exit site infection unresponsive to antibiotics, catheter-related bloodstream infection with severe sepsis, persistent bacteremia despite appropriate antibiotic therapy, infection with certain organisms like Staphylococcus aureus, Pseudomonas, fungi, or mycobacteria, or evidence of metastatic infection such as endocarditis or osteomyelitis. The decision to remove the catheter should be based on the severity of the infection and the patient's clinical condition 1. Before removal, blood cultures should be obtained and empiric antibiotic therapy initiated, typically with vancomycin plus gram-negative coverage like cefepime or a carbapenem 1. For uncomplicated infections, antibiotics are generally continued for 2-3 weeks, while complicated infections require 4-6 weeks of treatment 1. A new catheter should be placed at a different site once the patient is clinically stable and blood cultures are negative 1. Some key points to consider when deciding on catheter removal include:
- The type of organism causing the infection, with certain organisms like Staphylococcus aureus, Pseudomonas, fungi, or mycobacteria requiring catheter removal 1
- The presence of tunnel infection or exit site infection unresponsive to antibiotics 1
- The presence of catheter-related bloodstream infection with severe sepsis or persistent bacteremia despite appropriate antibiotic therapy 1
- The presence of metastatic infection such as endocarditis or osteomyelitis 1 Catheter removal is crucial because biofilm formation on the catheter surface can protect bacteria from antibiotics, making eradication of infection difficult without device removal 1. In cases where catheter preservation is necessary due to limited vascular access, antibiotic lock therapy may be attempted alongside systemic antibiotics, but this approach carries a higher risk of treatment failure and recurrent infection 1.
From the Research
Indications for Permcath Removal in Infection of ESRD
- Infection-related causes are a major concern for ESRD patients, with bloodstream infections being a significant risk for those undergoing hemodialysis 2.
- The removal of a permcath (long-term hemodialysis catheter) may be necessary in cases of catheter-related bloodstream infections, particularly those involving certain microorganisms such as Staphylococcus aureus, Pseudomonas species, Enterococcus species, and Candida species 2.
- A study on the placement of permcath in patients with ESRD found that catheter infection led to the removal of the catheter in one patient (2.2%) 1.5 months after surgery 3.
- Catheter-related bloodstream infections (CRBSIs) are a significant concern for ESRD patients, with a high rate of infections reported in patients receiving emergency-only hemodialysis via tunneled catheters 4, 5.
- The microbiologic etiology of CRBSIs in ESRD patients includes gram-positive and gram-negative bacteria, with Staphylococcus aureus being a common cause of infection 2, 5.
- The decision to remove a permcath in cases of infection should be made on a case-by-case basis, taking into account the severity of the infection, the type of microorganism involved, and the overall health of the patient 2.