Infection catheter-related

Catheter-related infections generally occur at the exit site or the portion of the catheter that is tunneled in the subcutaneous tissue. Previous infections increase the risk and incidence of catheter-related infections. 

Treatment Exit-site infections may be treated immediately with empiric coverage, or treatment may be delayed until cultures return. Empiric treatment of catheter-related infections should cover S. aureus. Coverage for P. aeruginosa should also be included if the patient has a history of infections with this organism.49 Cultures and sensitivity testing are particularly important in tailoring antibiotic therapy for catheter-related infections to ensure eradication of the organism and prevent recurrence or related peritonitis. 

Prevention of peritonitis and catheter-related infections starts when the catheter is placed. The exit site should be properly cared for until it is well healed before it can be used for PD. Patients should receive proper instructions for care of the catheter during this time period, which can last up to 2 weeks. Patients should also be instructed on the proper techniques to use for dialysate exchanges to minimize the risk of infections during exchanges, which is the most common cause of peritonitis. 

Clinical improvement should be seen within 48 hours of initiating treatment for peritonitis or catheter-related infections. Perform daily inspections of peritoneal fluid or the exit site to determine clinical improvement. Peritoneal fluid should become clear with improvement of peritonitis and erythema and discharge should remit with improvement of catheter-related infections. If no improvement is seen within 48 hours, obtain additional cultures and cell counts to determine the appropriate alterations in therapy. 

Parenteral nutrition can be a lifesaving therapy in patients with intestinal failure, but the oral or enteral route is preferred when providing nutrition support ( when the gut works, use it ). Compared with PN, enteral nutrition generally is associated with fewer infectious complications (e.g., pneumonia, intraabdominal abscess, and catheter-related infections) and potentially improved outcomes.1-3 However, if used in appropriate patients (i.e., patients with questionable intestinal function or when the intestine cannot be used), PN can be used safely and effectively and may improve nutrient delivery.4 Indications for PN are listed in Table 97-1.1... 

CRI Chronic renal insufficiency catheter-related infection EPS Extrapyramidal symptoms... 

Systemic catheter-related infections and local infections at catheter exit sites have been studied in relation to 479 central venous catheters in a prospective study in 311 patients in a general hospital in Australia (22). Local infections developed in association with 54 catheters (11%) and systemic infections with 32 (6.7%). Local... 

Catheter infections in recipients of parenteral nutrition are of particular concern in children and can result in line removal, deep vein thrombosis, or an increased risk of hver disease. The incidence of catheter-related infections in 47 children receiving long-term parenteral nutrition has been studied retrospectively, one goal being to identify potential risk factors (35). The children had 125 catheters and 207 catheter-years. The average infection rate was 2.1/1000 parenteral nutrition days. The only factor identified was that early onset of infection after starting parenteral nutrition appeared to predict a poor prognosis. 

Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, Klein JP. Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomy-cin/ciprofloxacin/heparin flush solution A randomized, multicenter, double-bhnd trial. J Qin Oncol 2000 18(6) 1269-78. 

Colomb V, Fabeiro M, Dabbas M, Goulet O, Merckx J, Ricour C. Central venous catheter-related infections in children on long-term home parenteral nutrition incidence and risk factors. Clin Nutr 2000 19(5) 355-9. 

Sheng WH, Ko WJ, Wang JT, Chang SC, Hsueh PR, Luh KT. Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients. Diagn Microbiol Infect... 

What is the most likely organism to cause a catheter-related infection in KM ... 

Coagulase-negative staphylococci, such as Staphylococcus epidermidis, are the most common causes of catheter-related infections due to their ability to adhere to prosthetic material. Staphylococcus aureus, aerobic gramnegative bacilli, and Candida albicans are also common causes of catheter-related infections. Depending on local susceptibility patterns, methicillin-resistant S. aureus (MRSA) may represent up to 20% of all isolates. In contrast, upward of 80% of S. epidermidis are methicillin-resistant (MRSE). 

C Treatment for catheter-related infections is often initiated empirically, with definitive therapy based on culture results and susceptibility. Dialysis catheters are usually permanently inserted lines, and patients on chronic hemodialysis are at higher risk for developing catheter-related infections secondary to staphylococcal species, particularly coagulase-negative staphylococci. Oral vancomycin is not appropriate because it does not achieve adequate blood levels to treat systemic infections. 

Maki D G, Weise C E, Sarafin H W 1977 A semiquantitative culture method for identifying intravenous-catheter-related infection. New England Journal of Medicine 296 1305-1309... 

O Grady N P, Alexander M, Dellinger E P et al 2002 Guidelines for the prevention of intravascular catheter-related infections. Pediatrics 110 e51... 

Nasal carriage of Staphylococcus aureus is associated with an increased risk of catheter-related infections and peritonitis. Prophylaxis with intranasal mupirocin (twice a day for 5 days every month) or mupirocin (daily) at the exit site can effectively reduce S. aureus infections. 

Patients who experience fever during HD should immediately have blood cultures obtained. If a temporary catheter is being used, it should be removed and the tip of the catheter cultured. Commonly used preventive approaches to catheter-related infections include minimizing use and duration of catheters, proper disinfection and sterile technique, and use of exit-site mupirocin or povidone-iodine ointment. Adoption of strict unit protocols that employ universal pre-... 

Table 45-8 hsts the numerous medical comphcations of PD. An average PD patient absorbs up to 60% of the dextrose in each exchange. This continuous supply of calories leads to increased adipose tissue deposition, decreased appetite, malnutrition, and altered requirements for insulin in diabetic patients. Fibrin formation in dialysate is common and can lead to obstruction of catheter outflow. Infectious comphcations of PD are a major cause of morbidity and mortality and are the leading cause of technique failure and transfer from PD to hemodialysis. The two predominant infectious complications are peritonitis and catheter-related infections, which include both exit-site and tunnel infections. 

---