From the Guidelines
The permcath should be removed in ESRD patients with bacteremia due to S. aureus, Pseudomonas species, or Candida species, as recommended by the Infectious Diseases Society of America 1. When managing bacteremia in ESRD patients with a permcath, it is crucial to consider the causative pathogen and the patient's clinical condition.
- For patients with bacteremia due to S. aureus, Pseudomonas species, or Candida species, catheter removal is strongly recommended, as stated in recommendation 57 of the guidelines 1.
- In cases of bacteremia due to other pathogens, such as gram-negative bacilli or coagulase-negative staphylococci, empirical intravenous antibiotic therapy can be initiated without immediate catheter removal, as suggested in recommendation 59 of the guidelines 1.
- However, if symptoms persist or metastatic infection is suspected, catheter removal should be considered, as indicated in recommendation 59 of the guidelines 1.
- The use of antibiotic lock therapy as an adjunct to systemic antibiotics may be considered in certain cases, as mentioned in recommendation 60 of the guidelines 1.
- It is essential to note that the decision to remove or retain the permcath should be made on a case-by-case basis, taking into account the patient's overall condition, the availability of alternative vascular access options, and the risk of complications associated with catheter removal or retention.
- The guidelines also emphasize the importance of empirical antibiotic therapy, including vancomycin and coverage for gram-negative bacilli, as stated in recommendation 61 of the guidelines 1.
From the Research
Vascular Access Infection in ESRD Patients
- Infection is a common cause of morbidity and mortality in end-stage renal disease (ESRD) patients, with gram-positive organisms being the most common cause 2.
- Bacteremia is a significant risk for ESRD patients, particularly those undergoing hemodialysis, with a rate of 0.7 to 1.4 episodes per 100 patient-care months 3.
Risk of Bloodstream Infection with Different Vascular Access Types
- The use of central venous catheters (CVCs) is associated with a higher risk of bloodstream infection (BSI) compared to arteriovenous fistulas (AVFs) or arteriovenous grafts (AVGs) 4, 5.
- Incident fistula use is associated with a 61% lower risk of BSI compared to incident CVC or graft use 4.
- Prevalent fistula or graft use is associated with a lower risk of BSI compared to prevalent CVC use 4.
Management of Vascular Access-Related Infections
- There is no direct evidence to suggest that removing the permcath is necessary in cases of bacteremia in ESRD patients.
- However, the use of permanent vascular access, such as AVFs or AVGs, is associated with a lower risk of infection and may be preferred over CVCs 4, 5.
- Clinicians should be aware of the many medical complications associated with ESRD and take steps to prevent and manage infections, including the use of appropriate vascular access types and infection control measures 6.