Catheter-related infections treatment

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. 

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. 

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. 

TREATMENT Prophylaxis of Peritonitis and Catheter-Related Infections... 

The number of people diagnosed with end-stage kidney disease (ESKD) in 2002 exceeded 400,000. There were over 100,000 new cases of ESKD in 2002. The primary therapeutic options for these individuals are hemodialysis, peritoneal dialysis, and/or renal transplantation. Renal transplantation is the preferred long-term therapeutic option for most patients with ESKD because it provides patients with the greatest potential improvement in overall quality of life. Dialysis catheter-related infections, update peritoneal dialysis-associated peritonitis, and scheduled dialysis treatments are avoided, and dietary restrictions are fewer. While the analysis of quality of life is complex, patients generally report improved quality of life following transplantation as compared with patients on maintenance dialysis. ... 

Published guidelines on the management of catheter-related infections are in favor of the use of ALT for the treatment of catheter-related infections [24]. The in vitro stability of antibiotic-heparin combinations in CVCs was studied by Vercaigne et al. [25]. While ciprofloxacin produced immediate precipitation with heparin, cefazolin, vancomycin and ceftazidime at 10 mg/ml and gentamycin at 5 mg/ml were successfully incubated with heparin (5,000 U/ml) for 72 h in the central venous catheter lumen. Although free antibiotic in CVC solution was reduced, the final concentration was still sufficient for an effective antibiotic-heparin lock [25]. Good evidence is available to support ALT in the prevention of catheter-related bacteremia in patients on hemodialysis [26,27]. However, others have reported that the use of ALT may be limited due to antibiotic toxicity and the appearance of antibiotic-resistant microbial isolates [28, 29]. 

Raad I, Bompart F, Hachem R. Prospective, randomized dose-ranging open phase II pilot study of quinupristin/dalfo-pristin versus vancomycin in the treatment of catheter-related staphylococcal bacteremia. Eur J Clin Microbiol Infect Dis 1999 18(3) 199-202. 

Antibiotic-lock therapy (ALT) is used in addition to systemic treatment for CVC-related infections. After filling both catheter lumens with a mix of antibiotic and anticoagulant at the end of dialysis (catheter locking), antibiotic concentrations inside the catheter reach very high levels, much higher than the con-... 

Infections can be limited to the PD catheter exit site, or intraperitoneal potentially causing peritonitis [32]. Early recognition of the sign and symptoms of infection is an essential starting point for the successful treatment of PD-related infection. Education of the patient and other caregivers is necessary, so that if signs and symptoms of an infection become evident, they will rapidly notify the physician and obtain appropriate treatment. Patient safety requires that the patient and caregivers be actively involved in the process of care. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Side effects, such as headache and jaw pain, are observed, but the major drawbacks with epoprostenol therapy relate to its delivery. Epoprostenol has an extremely short half-life in the blood (2-3 min) and therefore must be administered by continuous intravenous infusion via a surgically implanted central vein catheter. This can lead to complications such as local infections, sepsis, or catheter-associated thrombosis. In addition, interruption of therapy due, for example, to pump failure can lead to a life-threatening rebound of symptoms. The compound itself is unstable at room temperature and must be stored in the refrigerator. Despite these severe drawbacks, i.v. epoprosenol remains a useful treatment for patients presenting with WHO class IV PAH. The problems with epoprostenol have led to the development of alternative agents. 

UTls are one of the most common bacterial infections in humans. Most of these infections follow instrumentation of the urinary tract, mainly urinary catheterization see Fig. 3), with the development of catheter-associated bacteriuria directly related to the duration of catheterization (18). BPI easily allows spatial information to be monitored sequentially throughout the entire disease process, from cystitis to ascending UTIs see Fig. 4 and Color Plate 8, following p. 46), as well as treatment efficacy and relapse in diseased or asymptomatic animals all without exogenous sampling (10). 

Weightman NC, Simpson EM, Speller DC, Mott MG, Oakhill A (1988) Bacteraemia related to indwelling central venous catheters prevention, diagnosis and treatment. Eur J Clin Microbiol Infect Dis 7 125-129... 

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