Program Book - Keck School of Medicine of USC - University of ...

Replacement of InfectedCatheters over Guidewire• Beathard, J AM Soc Nephrol, 1999• 123 cases, three groups: Catheter exchange withnew tunnel, without new tunnel, or removal anddelayed re-insertion• 75 – 85% cure at 45 days, no diff between groups• Tanriover, et al, Kidney Intl, 2000• 69 cases without overt sepsis• 31 immediate guidewire exchange, 38 delayed• No difference between groups in Infection freesurvival ~ 60% @ 50 days• KDOQI 2006 Guidelines• Recommended exchange over guidewire in absenceof gross infection/sepsisManagement of CRB• Mokrzycki, et al, Am Journal of Kidney Diseases, 2006• Compared outcomes of CRB in 223 cases in 7dialysis units w/wo dedicated catheter infectionmanagement team• Dedicated team associated with 73% (p < .02)decrease in combined endpoint of recurrentbacteremia and septic death• Guttman et al, J Vasc Interv Radiol, 2011• 61 cases, 25 guidewire exchange, 35 same dayremoval/replacement at new site• Infection rate 4.4 vs 2.3 per 1000 cath days (p = .49)Management of CRB• Mokrzycki et al, NephrolDial Transplant, 2006• Multivariate analysis in226 patients• Guidewire exchange vsremoval / delayedreplacement equivalent• Predictors of treatmentfailure were cathetersalvage (OR 5.4, p =.003) and S. aureusinfection (OR 4.2, p=.002)103