Semin intervent Radiol 2009; 26(2): 139-143
DOI: 10.1055/s-0029-1222458
© Thieme Medical Publishers

Catheter-Related Bloodstream Infections

Tracie A. Wilcox1
  • 1Department of Medicine, University of Chicago, Chicago, Illinois
Further Information

Publication History

Publication Date:
29 June 2009 (online)


Tunneled, cuffed, double-lumen catheters are commonly used for long-term venous access in hemodialysis patients. Complications of these catheters, including catheter-related infection, are a major cause of morbidity and resource utilization in the hemodialysis population. Treatment of catheter-related bloodstream infections includes the use of antibiotics and evaluation of the need for catheter removal or exchange. Measures to prevent catheter-related infections include use of an aseptic technique and antiseptic cleaning solution, elimination of Staphylococcus aureus nasal carriage, topical exit site application of antibiotics, use of antibiotic lock solutions, and use of catheters and cuffs coated or impregnated with antimicrobial or antiseptic agents. This review article will provide an update on the prevalence, diagnosis, treatment, and prevention of catheter-related infections in the hemodialysis population.


  • 1 National Kidney Foundation . KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis adequacy, peritoneal dialysis adequacy and vascular access.  Am J Kidney Dis. 2006;  48(Suppl 1) S1-S322
  • 2 Tokars J I, Miller E R, Alter M J, Arduino M J. National surveillance of dialysis-associated diseases in the United States, 1997.  Semin Dial. 2000;  13(2) 75-85
  • 3 Mermel L, Farr B, Sheretz R J et al.. Guidelines for the management of intravascular catheter related infections—Executive Summary.  Clin Infect Dis. 2001;  32 1249-1272
  • 4 Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S. Canadian Nosocomial Infection Surveillance Program . Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients.  Am J Infect Control. 2004;  32(3) 155-160
  • 5 Saad T F. Bacteremia associated with tunneled, cuffed hemodialysis catheters.  Am J Kidney Dis. 1999;  34(6) 1114-1124
  • 6 Beathard G A. Catheter management protocol for catheter-related bacteremia prophylaxis.  Semin Dial. 2003;  16(5) 403-405
  • 7 Ramanathan V, Chiu E J, Thomas J T, Khan A, Dolson G M, Darouiche R O. Healthcare costs associated with hemodialysis catheter-related infections: a single-center experience.  Infect Control Hosp Epidemiol. 2007;  28(5) 606-609
  • 8 Danese M D, Griffiths R I, Dylan M, Yu H T, Dubois R, Nissenson A R. Mortality differences among organisms causing septicemia in hemodialysis patients.  Hemodial Int. 2006;  10(1) 56-62
  • 9 Nissenson A R, Dylan M L, Griffiths R I et al.. Clinical and economic outcomes of Staphylococcus aureus septicemia in ESRD patients receiving hemodialysis.  Am J Kidney Dis. 2005;  46(2) 301-308
  • 10 Center for Disease Control and Prevention . Guidelines for the Prevention of Intravascular Catheter-Related Infections.  MMWR Morb Mortal Wkly Rep. 2002;  51(RR10) 1-26
  • 11 Maki D G, Mermel L A. Infections due to infusion therapy. In: Bennett JV, Brachman PS Hospital Infections. Philadelphia; Lippincott-Raven 1998: 689-724
  • 12 Safdar N, Fine J P, Maki D G. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection.  Ann Intern Med. 2005;  142(6) 451-466
  • 13 Fan S T, Teoh-Chan C H, Lau K F. Evaluation of central venous catheter sepsis by differential quantitative blood culture.  Eur J Clin Microbiol Infect Dis. 1989;  8(2) 142-144
  • 14 Blot F, Schmidt E, Nitenberg G et al.. Earlier positivity of central-venous- versus peripheral-blood cultures is highly predictive of catheter-related sepsis.  J Clin Microbiol. 1998;  36(1) 105-109
  • 15 Maki D G, Weise C E, Sarafin H W. A semiquantitative culture method for identifying intravenous-catheter-related infection.  N Engl J Med. 1977;  296 1305-1309
  • 16 Cooper E T, Cohen R M, Berns J S, Kornfield Z N, Trerotola S O. Impact of tip culture on the management of infected tunneled hemodialysis catheters.  J Vasc Interv Radiol. 2007;  18(10) 1227-1231
  • 17 Jean G, Charra B, Chazot C et al.. Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias.  Nephron. 2002;  91(3) 399-405
  • 18 Nguyen M H, Peacock Jr J E, Tanner D C et al.. Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study.  Arch Intern Med. 1995;  155(22) 2429-2435
  • 19 Maya I D, Carlton D, Estrada E, Allon M. Treatment of dialysis catheter-related Staphylococcus aureus bacteremia with an antibiotic lock: a quality improvement report.  Am J Kidney Dis. 2007;  50(2) 289-295
  • 20 Capdevila J A, Segarra A, Planes A M et al.. Successful treatment of haemodialysis catheter-related sepsis without catheter removal.  Nephrol Dial Transplant. 1993;  8(3) 231-234
  • 21 Shaffer D. Catheter-related sepsis complicating long-term, tunnelled central venous dialysis catheters: management by guidewire exchange.  Am J Kidney Dis. 1995;  25(4) 593-596
  • 22 Robinson D, Suhocki P, Schwab S J. Treatment of infected tunneled venous access hemodialysis catheters with guidewire exchange.  Kidney Int. 1998;  53(6) 1792-1794
  • 23 Tanriover B, Carlton D, Saddekni S et al.. Bacteremia associated with tunneled dialysis catheters: Comparison of two treatment strategies.  Kidney Int. 2000;  57 2151-2155
  • 24 Nguyen M H, Peacock Jr J E, Tanner D C et al.. Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study.  Arch Intern Med. 1995;  155(22) 2429-2435
  • 25 Miller D L, O'Grady N P. Guidelines for the prevention of intravascular catheter-related infections: recommendations relevant to interventional radiology.  J Vasc Interv Radiol. 2003;  14(2 Pt 1) 133-136
  • 26 Ryan J M, Ryan B M, Smith T P. Antibiotic prophylaxis in interventional radiology.  J Vasc Interv Radiol. 2004;  15(6) 547-556
  • 27 Maki D G, Ringer M, Alvarado C J. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters.  Lancet. 1991;  338(8763) 339-343
  • 28 Yu V L, Goetz A, Wagener M et al.. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. Efficacy of antibiotic prophylaxis.  N Engl J Med. 1986;  315(2) 91-96
  • 29 James M T, Conley J, Tonelli M, Manns B J, MacRae J, Hemmelgarn B R. Alberta Kidney Disease Network . Meta-analysis: antibiotics for prophylaxis against hemodialysis catheter-related infections.  Ann Intern Med. 2008;  148(8) 596-605
  • 30 Jaffer Y, Selby N M, Taal M W, Fluck R J, Mcintyre C W. A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection.  Am J Kidney Dis. 2008;  51(2) 223-241
  • 31 Zinner S H, Denny-Brown B C, Braun P, Burke J P, Toala P, Kass E H. Risk of infection with intravenous indwelling catheters: effect of application of antibiotic ointment.  J Infect Dis. 1969;  120(5) 616-619
  • 32 Maki D G, Band J D. A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter-related infection.  Am J Med. 1981;  70(3) 739-744
  • 33 Mermel L A. Prevention of intravascular catheter-related infections.  Ann Intern Med. 2000;  132(5) 391-402
  • 34 Veenstra D L, Saint S, Saha S, Lumley T, Sullivan S D. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis.  JAMA. 1999;  281(3) 261-267
  • 35 Darouiche R O, Raad I I, Heard S O Catheter Study Group et al. A comparison of two antimicrobial-impregnated central venous catheters.  N Engl J Med. 1999;  340(1) 1-8

Tracie A WilcoxM.D. 

Assistant Professor of Clinical Medicine, Department of Medicine

University of Chicago, 5841 S. Maryland Avenue, MC 3051, Chicago, IL 60637