Abstract

Research Article

Evaluation of catheter related bacteremia in patients with end stage renal disease on hemodialysis

Jawad K Manuti*, Ali Mohammed Saadoon, Talal Shakir Jawad and Ali Ghafil Alawn

Published: 25 April, 2023 | Volume 7 - Issue 1 | Pages: 032-041

Infections are common complications among patients on chronic hemodialysis. Hemodialysis patients with a catheter have a 2- to 3-fold increased risk of hospitalization for infection and death compared with patients with an arteriovenous fistula or graft [1]. 

Read Full Article HTML DOI: 10.29328/journal.jcn.1001105 Cite this Article Read Full Article PDF

Keywords:

Catheter; Hemodialysis; Bacteremia

References

  1. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. 2001 Oct;60(4):1443-51. doi: 10.1046/j.1523-1755.2001.00947.x. PMID: 11576358.
  2. Vassalotti JA, Jennings WC, Beathard GA, Neumann M, Caponi S, Fox CH, Spergel LM; Fistula First Breakthrough Initiative Community Education Committee. Fistula first breakthrough initiative: targeting catheter last in fistula first. Semin Dial. 2012 May;25(3):303-10. doi: 10.1111/j.1525-139X.2012.01069.x. Epub 2012 Apr 4. PMID: 22487024.
  3. Allon M, Work J. Venous Catheter Access for Hemodialysis. In: Daugirdas JT, Blake PG, Ing TS, editors. Hand book of Dialysis. Philadelphia: Lippincott Williams. 2007; 87-104.
  4. National Kidney Foundation. Updates Clinical Practice Guidelines and Recommendations. 2006.
  5. Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int. 2011 Mar;79(6):587-598. doi: 10.1038/ki.2010.471. Epub 2010 Dec 22. PMID: 21178979.
  6. Lata C, Girard L, Parkins M, James MT. Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review. Can J Kidney Health Dis. 2016 May 5;3:24. doi: 10.1186/s40697-016-0115-8. PMID: 27152201; PMCID: PMC4857243.
  7. Allon M. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004 Nov;44(5):779-91. PMID: 15492943.
  8. Nassar GM, Ayus JC. Infectious complications of the hemodialysis access. Kidney Int. 2001 Jul;60(1):1-13. doi: 10.1046/j.1523-1755.2001.00765.x. PMID: 11422731.
  9. Beathard GA. Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol. 1999 May;10(5):1045-9. doi: 10.1681/ASN.V1051045. PMID: 10232691.
  10. Jaber BL. Bacterial infections in hemodialysis patients: pathogenesis and prevention. Kidney Int. 2005 Jun;67(6):2508-19. doi: 10.1111/j.1523-1755.2005.00364.x. PMID: 15882306.
  11. Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis. 2005 Sep;46(3):501-8. doi: 10.1053/j.ajkd.2005.05.024. PMID: 16129212.
  12. Weijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant. 2004 Mar;19(3):670-7. doi: 10.1093/ndt/gfg581. PMID: 14767025.
  13. Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int. 2011 Mar;79(6):587-598. doi: 10.1038/ki.2010.471. Epub 2010 Dec 22. PMID: 21178979.
  14. Krishnasami Z, Carlton D, Bimbo L, Taylor ME, Balkovetz DF, Barker J, Allon M. Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution. Kidney Int. 2002 Mar;61(3):1136-42. doi: 10.1046/j.1523-1755.2002.00201.x. PMID: 11849468.
  15. Poole CV, Carlton D, Bimbo L, Allon M. Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen. Nephrol Dial Transplant. 2004 May;19(5):1237-44. doi: 10.1093/ndt/gfh041. Epub 2004 Feb 19. PMID: 14993504.
  16. Sychev D, Maya ID, Allon M. Clinical management of dialysis catheter-related bacteremia with concurrent exit-site infection. Semin Dial. 2011 Mar-Apr;24(2):239-41. doi: 10.1111/j.1525-139X.2011.00869.x. PMID: 21517993; PMCID: PMC4017937.
  17. Lisa MM, Edward C, Christine D, Swapnil H, Joanne K, Mercedeh K, Charmaine L, Rick L, Louise M, Matthew O, Jennifer M. Canadian Journal of Kidney Health and Disease. sagepub.com/journals. Permissions.nav. 2016; 3:1–11. DOI: 10.1177/205435811666912
  18. Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006 Jul;48 Suppl 1:S248-73. doi: 10.1053/j.ajkd.2006.04.040. PMID: 16813991.
  19. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011 May;52(9):e162-93. doi: 10.1093/cid/cir257. Epub 2011 Apr 1. PMID: 21460264; PMCID: PMC3106269.
  20. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1;49(1):1-45. doi: 10.1086/599376. Erratum in: Clin Infect Dis. 2010 Apr 1;50(7):1079. Dosage error in article text. Erratum in: Clin Infect Dis. 2010 Feb 1;50(3):457. PMID: 19489710; PMCID: PMC4039170.
  21. Chan KE, Warren HS, Thadhani RI, Steele DJ, Hymes JL, Maddux FW, Hakim RM. Prevalence and outcomes of antimicrobial treatment for Staphylococcus aureus bacteremia in outpatients with ESRD. J Am Soc Nephrol. 2012 Sep;23(9):1551-9. doi: 10.1681/ASN.2012010050. Epub 2012 Aug 16. PMID: 22904350; PMCID: PMC3431413.
  22. Capdevila JA, Segarra A, Planes AM, Ramírez-Arellano M, Pahissa A, Piera L, Martínez-Vázquez JM. Successful treatment of haemodialysis catheter-related sepsis without catheter removal. Nephrol Dial Transplant. 1993;8(3):231-4. PMID: 8385290.
  23. Aslam S, Vaida F, Ritter M, Mehta RL. Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia. J Am Soc Nephrol. 2014 Dec;25(12):2927-41. doi: 10.1681/ASN.2013091009. Epub 2014 May 22. PMID: 24854263; PMCID: PMC4243345.
  24. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1;49(1):1-45. doi: 10.1086/599376. Erratum in: Clin Infect Dis. 2010 Apr 1;50(7):1079. Dosage error in article text. Erratum in: Clin Infect Dis. 2010 Feb 1;50(3):457. PMID: 19489710; PMCID: PMC4039170.
  25. Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, Craven DE; Infectious Diseases Society of America; American College of Critical Care Medicine; Society for Healthcare Epidemiology of America. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis. 2001 May 1;32(9):1249-72. doi: 10.1086/320001. Epub 2001 Apr 3. PMID: 11303260.
  26. Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, Decruyenaere J, Vogelaers D, Colardyn F, Vandewoude KH. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005 Dec 1;41(11):1591-8. doi: 10.1086/497833. Epub 2005 Oct 25. PMID: 16267731.
  27. Raad II, Hanna HA, Darouiche RO. Diagnosis of catheter-related bloodstream infections: is it necessary to culture the subcutaneous catheter segment? Eur J Clin Microbiol Infect Dis. 2001 Aug;20(8):566-8. doi: 10.1007/s100960100562. PMID: 11681436.
  28. Safdar N, Fine JP, Maki DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Ann Intern Med. 2005 Mar 15;142(6):451-66. doi: 10.7326/0003-4819-142-6-200503150-00011. Erratum in: Ann Intern Med. 2005 May 3;142(9):803. PMID: 15767623.
  29. Gaur AH, Flynn PM, Heine DJ, Giannini MA, Shenep JL, Hayden RT. Diagnosis of catheter-related bloodstream infections among pediatric oncology patients lacking a peripheral culture, using differential time to detection. Pediatr Infect Dis J. 2005 May;24(5):445-9. doi: 10.1097/01.inf.0000160950.83583.7f. PMID: 15876945.
  30. Raad I, Hanna HA, Alakech B, Chatzinikolaou I, Johnson MM, Tarrand J. Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections. Ann Intern Med. 2004 Jan 6;140(1):18-25. doi: 10.7326/0003-4819-140-1-200401060-00007. PMID: 14706968.
  31. Moise PA, Sakoulas G, Forrest A, Schentag JJ. Vancomycin in vitro bactericidal activity and its relationship to efficacy in clearance of methicillin-resistant Staphylococcus aureus bacteremia. Antimicrob Agents Chemother. 2007 Jul;51(7):2582-6. doi: 10.1128/AAC.00939-06. Epub 2007 Apr 23. PMID: 17452488; PMCID: PMC1913284.
  32. Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC Jr, Eliopoulos GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol. 2004 Jun;42(6):2398-402. doi: 10.1128/JCM.42.6.2398-2402.2004. PMID: 15184410; PMCID: PMC427878.
  33. Lorente L, Jiménez A, Santana M, Iribarren JL, Jiménez JJ, Martín MM, Mora ML. Microorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site. Crit Care Med. 2007 Oct;35(10):2424-7. doi: 10.1097/01.CCM.0000284589.63641.B8. PMID: 17717493.
  34. Reboli AC, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, Betts R, Wible M, Goldstein BP, Schranz J, Krause DS, Walsh TJ; Anidulafungin Study Group. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007 Jun 14;356(24):2472-82. doi: 10.1056/NEJMoa066906. PMID: 17568028.
  35. Kuse ER, Chetchotisakd P, da Cunha CA, Ruhnke M, Barrios C, Raghunadharao D, Sekhon JS, Freire A, Ramasubramanian V, Demeyer I, Nucci M, Leelarasamee A, Jacobs F, Decruyenaere J, Pittet D, Ullmann AJ, Ostrosky-Zeichner L, Lortholary O, Koblinger S, Diekmann-Berndt H, Cornely OA; Micafungin Invasive Candidiasis Working Group. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007 May 5;369(9572):1519-1527. doi: 10.1016/S0140-6736(07)60605-9. PMID: 17482982.
  36. Kuhn DM, George T, Chandra J, Mukherjee PK, Ghannoum MA. Antifungal susceptibility of Candida biofilms: unique efficacy of amphotericin B lipid formulations and echinocandins. Antimicrob Agents Chemother. 2002 Jun;46(6):1773-80. doi: 10.1128/AAC.46.6.1773-1780.2002. PMID: 12019089; PMCID: PMC127206.
  37. Raad I, Hanna H, Boktour M, Girgawy E, Danawi H, Mardani M, Kontoyiannis D, Darouiche R, Hachem R, Bodey GP. Management of central venous catheters in patients with cancer and candidemia. Clin Infect Dis. 2004 Apr 15;38(8):1119-27. doi: 10.1086/382874. Epub 2004 Mar 26. Erratum in: Clin Infect Dis. 2004 Oct 15;39(8):1264. PMID: 15095217.
  38. Chee L, Brown M, Sasadeusz J, MacGregor L, Grigg AP. Gram-negative organisms predominate in Hickman line-related infections in non-neutropenic patients with hematological malignancies. J Infect. 2008 Apr;56(4):227-33. doi: 10.1016/j.jinf.2008.01.046. Epub 2008 Mar 17. PMID: 18342947.
  39. Rodríguez-Créixems M, Alcalá L, Muñoz P, Cercenado E, Vicente T, Bouza E. Bloodstream infections: evolution and trends in the microbiology workload, incidence, and etiology, 1985-2006. Medicine (Baltimore). 2008 Jul;87(4):234-249. doi: 10.1097/MD.0b013e318182119b. PMID: 18626306.
  40. Blot S, Janssens R, Claeys G, Hoste E, Buyle F, De Waele JJ, Peleman R, Vogelaers D, Vandewoude K. Effect of fluconazole consumption on long-term trends in candidal ecology. J Antimicrob Chemother. 2006 Aug;58(2):474-7. doi: 10.1093/jac/dkl241. Epub 2006 Jun 6. PMID: 16757503.
  41. Doulton T, Sabharwal N, Cairns HS, Schelenz S, Eykyn S, O'Donnell P, Chambers J, Austen C, Goldsmith DJ. Infective endocarditis in dialysis patients: new challenges and old. Kidney Int. 2003 Aug;64(2):720-7. doi: 10.1046/j.1523-1755.2003.00136.x. PMID: 12846771.
  42. Shroff GR, Herzog CA, Ma JZ, Collins AJ. Long-term survival of dialysis patients with bacterial endocarditis in the United States. Am J Kidney Dis. 2004 Dec;44(6):1077-82. doi: 10.1053/j.ajkd.2004.08.030. PMID: 15558529.
  43. National Council on Aging. 2002. Survey. 6: 11-18.
  44. American Diabetes Association. Standards of Medical Care in Diabetes-2018Abridged for Primary Care Providers. Clin Diabetes. 2018 Jan;36(1):14-37. doi: 10.2337/cd17-0119. PMID: 29382975; PMCID: PMC5775000.
  45. Daniel Pratt S. Evaluation of Liver Function. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL and Loscalzo J. Harrison’s Principles of Internal Medicine, 19th ed. New York, McGraw Hill: 2015; 1995 -1999.
  46. Hemoglobin Concentrations for the Diagnosis of Anemia and Assessment of Severity, Vitamin and Mineral Nutrition Information System, World Health Organization, Geneva, Switzerland. 2011.
  47. Steven M, Holland H, John I, Gallin S. Disorders of Granulocytes and Monocytes. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL and Loscalzo J. Harrison’s Principles of Internal Medicine, 19th New York, McGraw Hill. 2015; 413-423.
  48. Center for Disease Control and Prevention. Clinician Guide for Collecting Cultures. 2015.
  49. Fowler VG Jr, Justice A, Moore C, Benjamin DK Jr, Woods CW, Campbell S, Reller LB, Corey GR, Day NP, Peacock SJ. Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia. Clin Infect Dis. 2005 Mar 1;40(5):695-703. doi: 10.1086/427806. Epub 2005 Feb 4. PMID: 15714415.
  50. Pigrau C, Rodríguez D, Planes AM, Almirante B, Larrosa N, Ribera E, Gavaldà J, Pahissa A. Management of catheter-related Staphylococcus aureus bacteremia: when may sonographic study be unnecessary? Eur J Clin Microbiol Infect Dis. 2003 Dec;22(12):713-9. doi: 10.1007/s10096-003-1041-0. Epub 2003 Nov 6. PMID: 14605943.
  51. Abraham J, Mansour C, Veledar E, Khan B, Lerakis S. Staphylococcus aureus bacteremia and endocarditis: the Grady Memorial Hospital experience with methicillin-sensitive S aureus and methicillin-resistant S aureus bacteremia. Am Heart J. 2004 Mar;147(3):536-9. doi: 10.1016/j.ahj.2003.09.018. PMID: 14999206.
  52. Vergis EN, Hayden MK, Chow JW, Snydman DR, Zervos MJ, Linden PK, Wagener MM, Schmitt B, Muder RR. Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia. a prospective multicenter study. Ann Intern Med. 2001 Oct 2;135(7):484-92. doi: 10.7326/0003-4819-135-7-200110020-00007. PMID: 11578151.
  53. Lorente L, Jiménez A, Santana M, Iribarren JL, Jiménez JJ, Martín MM, Mora ML. Microorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site. Crit Care Med. 2007 Oct;35(10):2424-7. doi: 10.1097/01.CCM.0000284589.63641.B8. PMID: 17717493.
  54. Chee L, Brown M, Sasadeusz J, MacGregor L, Grigg AP. Gram-negative organisms predominate in Hickman line-related infections in non-neutropenic patients with hematological malignancies. J Infect. 2008 Apr;56(4):227-33. doi: 10.1016/j.jinf.2008.01.046. Epub 2008 Mar 17. PMID: 18342947.
  55. Allon M, Daugirdas J, Depner TA, Greene T, Ornt D, Schwab SJ. Effect of change in vascular access on patient mortality in hemodialysis patients. Am J Kidney Dis. 2006 Mar;47(3):469-77. doi: 10.1053/j.ajkd.2005.11.023. PMID: 16490626.
  56. Jaudah AK, Musa AK. Incidence and risk factors of central venous catheter and blood stream bacterial infections in hemodialysis patients: a cross sectional study. Life Science Archives (LSA). 2017; 3:1; 921-933.
  57. Farrington CA, Allon M. Complications of Hemodialysis Catheter Bloodstream Infections: Impact of Infecting Organism. Am J Nephrol. 2019;50(2):126-132. doi: 10.1159/000501357. Epub 2019 Jun 26. PMID: 31242483; PMCID: PMC6935870.
  58. Awad SM. Chronic renal failure in Al-Anbar of Iraq. Saudi J Kidney Dis Transpl. 2011 Nov;22(6):1280-4. PMID: 22089804.
  59. Malekmakan L, Haghpanah S, Pakfetrat M, Malekmakan A, Khajehdehi P. Causes of chronic renal failure among Iranian hemodialysis patients. Saudi J Kidney Dis Transpl. 2009 May;20(3):501-4. PMID: 19414964.
  60. Sanavi S, Ghods A, Afshar R. Catheter associated infections in hemodialysis patients. Saudi J Kidney Dis Transpl. 2007 Mar;18(1):43-6. PMID: 17237890.
  61. Samani S, Saffari M, Charkhchian M, Khaki A. Incidence and risk factors of bloodstream catheter-related infections in hemodialysis patients. Comparative Clinical Pathology. 2015 Mar 1; 24(2):275-9.
  62. Zanoni F, Pavone L, Binda V, Tripepi G, D'Arrigo G, Scalamogna A, Messa P. Catheter-related bloodstream infections in a nephrology unit: Analysis of patient- and catheter-associated risk factors. J Vasc Access. 2021 May;22(3):337-343. doi: 10.1177/1129729820939762. Epub 2020 Jul 10. PMID: 32648807.
  63. Hadian B, Zafarmohtashami A, Razani M. Catheter-related blood stream infections in hemodialysis patients. Journal of Renal Injury Prevention. 2020 Apr 23; 9(4):e34.
  64. Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int. 2011 Mar;79(6):587-598. doi: 10.1038/ki.2010.471. Epub 2010 Dec 22. PMID: 21178979.
  65. Lata C, Girard L, Parkins M, James MT. Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review. Can J Kidney Health Dis. 2016 May 5;3:24. doi: 10.1186/s40697-016-0115-8. PMID: 27152201; PMCID: PMC4857243.
  66. Thompson S, Wiebe N, Klarenbach S, Pelletier R, Hemmelgarn BR, Gill JS, Manns BJ, Tonelli M; Alberta Kidney Disease Network. Catheter-related blood stream infections in hemodialysis patients: a prospective cohort study. BMC Nephrol. 2017 Dec 8;18(1):357. doi: 10.1186/s12882-017-0773-5. PMID: 29221439; PMCID: PMC5723103.
  67. Farrington CA, Allon M. Management of the Hemodialysis Patient with Catheter-Related Bloodstream Infection. Clin J Am Soc Nephrol. 2019 Apr 5;14(4):611-613. doi: 10.2215/CJN.13171118. Epub 2019 Mar 5. PMID: 30837242; PMCID: PMC6450352.
  68. Mahmood SN, Asif S, Anwar MA, Naveed OK. Frequency and microbiological profile of catheter-related infections in hemodialysis patients receiving gentamicin as antimicrobial lock therapy for prophylaxis. Pakistan Journal of Kidney Diseases. 2020; 4(03).
  69. Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. J Infect Public Health. 2017 Jul-Aug;10(4):403-408. doi: 10.1016/j.jiph.2016.06.008. Epub 2016 Aug 8. PMID: 27423929.
  70. Powers AC. Diabetes Mellitus: Complications. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL and Loscalzo J. Harrison’s Principles of Internal Medicine, 19th New York, McGraw Hill. 2015; 2422-2430.
  71. Ghonemy TA, Farag SE, Soliman SA, Amin EM, Zidan AA. Vascular access complications and risk factors in hemodialysis patients: A single center study. Alexandria Journal of Medicine. 2016 Mar 30; 52(1):67-71.
  72. Katneni R, Hedayati SS. Central venous catheter-related bacteremia in chronic hemodialysis patients: epidemiology and evidence-based management. Nat Clin Pract Nephrol. 2007 May;3(5):256-66. doi: 10.1038/ncpneph0447. PMID: 17457359.
  73. Leone S, Suter F. Severe bacterial infections in haemodialysis patients. Infez Med. 2010 Jun;18(2):79-85. PMID: 20610929.
  74. Gupta S, Mallya SP, Bhat A, Baliga S. Microbiology of Non-Tunnelled Catheter-Related Infections. J Clin Diagn Res. 2016 Jul;10(7):DC24-8. doi: 10.7860/JCDR/2016/19058.8155. Epub 2016 Jul 1. PMID: 27630843; PMCID: PMC5020248.
  75. Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int. 2011 Mar;79(6):587-598. doi: 10.1038/ki.2010.471. Epub 2010 Dec 22. PMID: 21178979.
  76. Daugirdos J1. Hand book of dialysis third edition, lippincott williams & wilkins, 2001; 4:43; 50:28:496-500.
  77. Labriola L. Antibiotic locks for the treatment of catheter-related blood stream infection: Still more hope than data. Semin Dial. 2019 Sep;32(5):402-405. doi: 10.1111/sdi.12807. Epub 2019 Apr 4. PMID: 30950116.
  78. Kumbar L, Yee J. Current Concepts in Hemodialysis Vascular Access Infections. Adv Chronic Kidney Dis. 2019 Jan;26(1):16-22. doi: 10.1053/j.ackd.2018.10.005. PMID: 30876612.

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?