From the Guidelines
The most common cause of hemodialysis line infections is Staphylococcus species, particularly Staphylococcus aureus and coagulase-negative staphylococci. These infections typically develop when bacteria colonize the catheter hub or migrate along the external surface of the catheter, forming biofilms that protect the organisms from antibiotics and host defenses 1. According to the 2009 clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection, CRBSI in patients who are undergoing hemodialysis is most often due to coagulase-negative staphylococci or S. aureus 1.
Key Points
- Treatment usually involves systemic antibiotics tailored to the specific pathogen, with vancomycin often used empirically until culture results are available 1.
- For severe infections, catheter removal is necessary, though antibiotic lock therapy may be attempted for salvage in certain cases 1.
- Prevention strategies include strict aseptic technique during catheter insertion and manipulation, chlorhexidine skin antisepsis, and antimicrobial lock solutions in high-risk patients.
- Infections are serious complications that can lead to bacteremia, endocarditis, and other metastatic infections, with significant morbidity and mortality rates if not properly managed 1.
Recent Guidelines
The 2020 core curriculum on targeting zero infections in the outpatient dialysis unit emphasizes the importance of strict adherence to hand hygiene, use of appropriate personal protective equipment, transmission-based precautions, and maintaining aseptic technique while connecting the access to the hemodialysis machine to substantially decrease the likelihood of bacterial infections 1.
Management
Prompt recognition and treatment of hemodialysis line infections are crucial to prevent complications and improve patient outcomes. This includes administering systemic antibiotics, considering catheter removal or exchange, and implementing prevention strategies to reduce the risk of infection 1.
From the Research
Causes of Hemodialysis Line Infection
- The most common cause of hemodialysis (HD) line infection is Staphylococcus aureus bloodstream infections, with a rate of 17.9 per 100 patient-years 2.
- Staphylococcus aureus is the most common causative organism isolated in HD patients, along with Pseudomonas aeruginosa in peritoneal dialysis (PD) patients 3.
- The majority of cases (83%) of S. aureus bloodstream infections are related to vascular catheters, highlighting the need for proper catheter care and management 2.
Risk Factors and Prevention
- The use of intravascular catheters is a significant risk factor for HD line infection, and reducing their use or implementing alternative vascular access, such as arteriovenous fistulae, can help minimize this risk 2, 4.
- Improving hygiene conditions during catheter insertion, treating S. aureus nasal carriers, and regular treatment of the catheter's exit site can also reduce the risk of infectious episodes 3.
- The implementation of strong infection control policies in hemodialysis units and appropriate use of antibiotics are essential in preventing bloodstream infections 4.