{"id":162,"date":"2018-04-23T11:45:30","date_gmt":"2018-04-23T11:45:30","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=162"},"modified":"2023-03-09T12:22:51","modified_gmt":"2023-03-09T12:22:51","slug":"line-infection","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/dialysis-handbook\/dialysis-information\/line-infection\/","title":{"rendered":"Haemodialysis Catheter (Tunneled Line) Infections"},"content":{"rendered":"

Line Infection Algorithm<\/strong><\/span><\/span><\/h3>\n

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Staphylococcus Aureus Infections<\/strong><\/span><\/span><\/h3>\n

Appendix 1<\/span><\/strong><\/p>\n

Staphylococcus aureus bacteraemia in dialysis patients is a serious illness with reported mortality up to 30%. Relapse is common, particularly when treatment is inadequate and dialysis lines are not removed. A number of serious complications can arise, including endocarditis, osteomyelitis and discitis.\u00a0 Treat with systemic antibiotics for 4 weeks.<\/span><\/p>\n

For MRSA empirically use IV vancomycin<\/a>. Please discuss with microbiology to ensure this is adequate therapy. If MIC is raised, alternative or adjunctive antibiotics may be required.<\/span><\/p>\n

For MSSA use IV flucloxacillin when possible. Vancomycin is less effective against MSSA than flucloxacillin and substantially increases the risk of treatment failure. If a patient is otherwise suitable for discharge before the treatment course (typically 4 weeks) is completed, consider use of IV flucloxacillin for as long as possible (ideally up to 10 days) whilst the patient remains in hospital, before switching to vancomycin on discharge. When vancomycin is being considered for treatment of MSSA bacteraemia this must be discussed with microbiology to determine whether different or adjunctive antibiotics are indicated.<\/span><\/p>\n

Cefazolin<\/a> is sometimes used to facilitate early discharge from hospital.<\/p>\n

A <\/span>critical<\/span> factor in treating line associated Staphylococcus aureus bacteraemia is <\/span>removal<\/b> of the dialysis line in order to prevent relapse of infection and reduce the risk of infective complications.\u00a0 A line should only be kept in situ if removal means that there is no alternative means of dialysis or if risk associated with removal outweighs risk of recurrent bacteraemia and risk of developing deep seated infection (e.g. discitis, osteomyelitis, endocarditis).<\/span><\/span><\/p>\n

If permcath cannot be removed then the patient may need up to 6 weeks of antibiotic therapy; discuss with Microbiology. Repeat blood cultures should be taken after 72 hours of treatment , if they remain positive then permcath should be removed.<\/span><\/p>\n

When permcaths are removed, ideally leave the patient line free (on antibiotic treatment) for as long as possible before replacing the line. A new permcath should preferably only be inserted after the patient has been afebrile for at least 48 hours with negative repeat blood cultures.<\/span><\/p>\n

Carefully examine \/ investigate appropriately for a deep-seated focus of infection, such as endocarditis or discitis. This is particularly relevant for relapsed staphylococcal aureus bacteraemia.<\/span><\/p>\n

Citralock line lock should be used after a patient has a single episode of staphylococcal aureus bacteraemia related to their dialysis line.<\/span><\/p>\n

A 14 day course may be considered in patients where the infected dialysis line is removed and fever and bacteraemia resolve within 72 hours of appropriate antibiotic therapy, the patient has no prosthetic intravascular device, there is no clinical evidence of metastatic infection, there is no evidence of endocarditis or thrombophlebitis and the patient is not diabetic or immunosuppressed.\u00a0<\/span><\/p>\n

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Non-Staphylococcal Infections<\/span>
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Appendix 2<\/span><\/strong><\/p>\n