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Author (up) Zhou, Z.; Guo, D.; Zhang, F.; Wang, T.; Zhang, G.; Zhou, B.
Title Predictors of failure of catheter salvage in incident hemodialysis patients Type Observational Study
Year 2013 Publication The International Journal of Artificial Organs Abbreviated Journal Int J Artif Organs
Volume 36 Issue 5 Pages 320-326
Keywords Anti-Bacterial Agents/*therapeutic use; Catheter-Related Infections/diagnosis/microbiology/*therapy; Catheterization, Central Venous/*adverse effects/*instrumentation; Catheters, Indwelling/*adverse effects; Central Venous Catheters/*adverse effects; Chi-Square Distribution; Device Removal; Humans; Kidney Failure, Chronic/*therapy; Logistic Models; Multivariate Analysis; Odds Ratio; Prospective Studies; *Renal Dialysis; Risk Factors; Salvage Therapy; Severity of Illness Index; Time Factors; Treatment Failure; Watchful Waiting
Abstract PURPOSE: Catheter-related bloodstream infection is a frequent complication for patients who use catheter as dialysis access. This study was performed to identify the risk factors for failed catheter salvage. METHODS: We enrolled patients who received non-tunneled catheters as initial vascular access during a two-year period. Catheter salvage was attempted in all symptomatically mild patients. Patients were prospectively followed for 8 weeks starting from the day of infection. Risk factors for salvage failure were explored. RESULTS: A total of 77 bacteremia episodes occurred in 69 patient, with an infection rate of 1.61 per 1,000 catheter days. Salvage was successful in 73.4% of all episodes. We found that higher ferritin levels (greater vs. lower than 500 mg/l, (odds ratio (OR) 6.388, 95% confidence interval (CI) 2.073, 19.686), higher phosphate levels (greater vs. lower than 5.5 mg/dl, OR 4.084, 95% CI 1.391, 11.978) and shorter time intervals between catheterization and infection (within vs. beyond 3 weeks, OR 4.190, 95% CI 1.279, 13.725) predicted salvage failure. CONCLUSIONS: Catheter salvage can be a reasonable initial strategy for symptomatically mild patients. We propose salvaging aggressively and waiting watchfully; however, clinical judgment is prior to any specific management protocol.
Address Department of Nephrology, Chengdu Military General Hospital, Chengdu, China
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0391-3988 ISBN Medium
Area Expedition Conference
Notes PMID:23645579 Approved no
Call Number ref @ user @ Serial 100544
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