From the Guidelines
Placing a temporary dialysis catheter in a patient with Staphylococcus aureus bacteremia is generally not recommended unless absolutely necessary for life-saving dialysis, and only after blood cultures have turned negative following appropriate antibiotic therapy, as suggested by 1.
Key Considerations
- The patient should receive anti-staphylococcal agents such as vancomycin, daptomycin, or an appropriate beta-lactam based on susceptibility testing for at least 48-72 hours before catheter placement, with documented negative blood cultures, as indicated by 1 and 1.
- During catheter placement, strict aseptic technique must be followed to minimize the risk of infection.
- The patient should continue receiving antibiotics for the full treatment course, typically 2-6 weeks depending on complications, as recommended by 1.
- Alternative approaches such as continuous renal replacement therapy through an existing central line or temporary peritoneal dialysis might be considered in consultation with infectious disease specialists if dialysis is urgently needed while bacteremia is still present.
Rationale
- S. aureus bacteremia carries a high risk of seeding the new catheter, potentially leading to persistent infection, endocarditis, or other metastatic complications, as highlighted by 1 and 1.
- The guidelines from the Infectious Diseases Society of America, as cited in 1 and 1, emphasize the importance of removing infected catheters and providing appropriate antimicrobial therapy to prevent such complications.
Clinical Approach
- A thorough assessment of the patient's condition and the urgency of dialysis needs should be conducted before making a decision about catheter placement.
- Consultation with infectious disease specialists is crucial in managing patients with S. aureus bacteremia who require dialysis, as they can provide guidance on the optimal treatment approach, including the use of antibiotics and the timing of catheter placement, as suggested by 1, 1, and 1.
From the Research
Temporary Dialysis Catheter Placement in Patients with Staph Aureus Positive in Blood
- The placement of a temporary dialysis catheter in patients with Staph aureus positive in blood is a complex issue, with various studies suggesting different approaches to management 2, 3, 4, 5, 6.
- A study published in 2007 found that routine antibiotic lock therapy is not appropriate for patients with S aureus catheter-related bacteremia, as it can lead to serious complications, particularly in patients with persistent fever 2.
- Another study from 2000 suggested that prevention of S aureus infections in dialysis patients can be aimed at treating nasal carriage or applying antibiotics at the catheter exit site to prevent colonization and subsequent infection of the catheter 3.
- The use of vancomycin as empiric therapy for methicillin-resistant S aureus bacteremia in hemodialysis patients has been questioned, as subtherapeutic concentrations of vancomycin can decrease S aureus susceptibility to vancomycin and daptomycin, and increase its survival to whole blood bactericidal action 4.
- A systematic approach to managing patients with S aureus bacteraemia, including identification of potential focus of infection, risk factors for complicated infection, and appropriate antibiotic treatment, is essential to prevent morbidity and mortality 5.
- The optimal choice of antibiotic therapy for vascular catheter-related bloodstream infections caused by Staphylococcus aureus is still a topic of debate, with some studies suggesting that vancomycin may not be the best option due to its decreasing activity against this organism and deficiencies in tissue penetration 6.