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Group n Symptoms Exit Site Treatment aXchng, catheter exchange over guidewire; Nutunl, catheter exchange over guidewire with a new tunnel and exit site; Delay, delayed catheter replacement. bThe character of the exit site did not influence this group. Xchng 49 Mild Normal Antibiotics for 3 wk, catheter exchange Nutunl 28 Mild Infected Antibiotics for 3 wk, catheter exchange, new tunnel and exit site Delay 37 Severe NAb Antibiotics for 3 wk, remove catheter, delay replacement Group Culture Curea Clinical Cureb Failure Indeterminantc aNegative blood culture 7 to 10 d after antibiotic therapy complete, plus 45 d free of symptoms. bForty-five days free of symptoms. cInfection with a new organism, death, or catheter removed before end of 45-d period for unrelated reason. Xchng (n = 49) 34 (69.4%) 9 (18.4%) 0 6 (12.2%) Nutunl (n = 28) 14 (50%) 7 (25%) 5 (17.8%) 2 (7.1%) Delay (n = 37) 27 (73%) 5 (13.5%) 3 (8.1%) 2 (5.4%) Group No. Indeterminate Different Organisma Catheter Removalb Deathc aInfection recurred within 45-d period, but with an organism different from the original. bThe catheter was removed during the 45-d period for unrelated reasons. cDeath was not related to catheter-related bacteremia. Xchng 6 4 1 1 Nutunl 2 2 Delay 2 1 1 Organism Isolates, n (%) Gram-positive cocci 104 (84.5%) Staphylococcus epidermidis 46 Staphylococcus aureus 37 Enterococcus faecalis 15 other group D enterococci 6 Gram-positive rods 2 (1.6%) Corynebacterium species 4 Gram-negative rods 41 (33.3%) Enterobacter cloacae 11 other Enterobacter species 2 Pseudomonas species 8 Acinetobacter baumanii 5 Citrobacter species 5 Serratia species 2 Klebsiella pneumoniae 4 Proteus mirabilis 1 Escherichia coli 1 Agrobacterium radiobacter 1 Alcaligenes species 1 Acid-fast organism 2 (1.6%) Mycobacterium fortuitum 2
Management of Bacteremia Associated with Tunneled-Cuffed Hemodialysis Catheters
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