The fluctuation profile of the infectious risk show that preventive precautions should target the first months of catheterization” Izoard et al (2017).
BACKGROUND: International guidelines recommend to limit the long-term use of central-veinous catheters in patients undergoing hemodialysis, because they expose the patient to a higher infectious risk than the fistulas. However, for some patients with comorbidity, switching to a permanent vascular access is not possible. In such case, the catheter is used for a longer period. It seems therefore important to study the influence of a prolonged duration of catheterization on infectious complications. The temporal fluctuation profile of the infectious risk is poorly studied in the literature and the results published may be contradictory.
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METHODS: This multicentric prospective study included 1053 incident tunneled catheters. Multivariate logistic regression was used to identify significant risk factors of infection. An infection-free survival analysis was performed afterwards to estimate the variation of the instantaneous infectious risk during catheterization.
RESULTS: The major risks factors of infections on tunneled catheters were: previous Staphylococcus aureus infection (aOR=1.95 [1.16-3.27]; P=0.012), diabetes (aOR=1.67 [1.16-2.41]; P=0.006), and long duration of catheterization (0-3months vs.≥24months: aOR=2.42 [1.34-4.36]; P=0.003). The survival analysis showed a higher risk of infections of tunneled catheters during the first months after placement. Risk declines over time.
CONCLUSIONS: The fluctuation profile of the infectious risk show that preventive precautions should target the first months of catheterization.
Izoard, S., Ayzac, L., Meynier, J., Seghezzi, J.C., Jolibois, B. and Tolani, M.L. (2016) Infections on catheters in hemodialysis: Temporal fluctuations of the infectious risk. September 22nd. [epub ahead of print]. [Article in French].
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