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Controlling exit site infections: Does it decrease the incidence of catheter‐related bacteremia in children on chronic hemodialysis?
Author(s) -
ONDER Ali Mirza,
CHANDAR Jayanthi,
COAKLEY Sheila,
FRANCOEUR Denise,
ABITBOL Carolyn,
ZILLERUELO Gaston
Publication year - 2009
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2009.00348.x
Subject(s) - bacteremia , medicine , hemodialysis , incidence (geometry) , catheter , etiology , hemodialysis catheter , antimicrobial , surgery , chlorhexidine , retrospective cohort study , antibiotics , microbiology and biotechnology , dentistry , physics , optics , biology
The aim of this retrospective study was to investigate whether the application of a chlorhexidine‐impregnated dressing (Biopatch ® ) at the exit site of tunneled‐cuffed hemodialysis catheters has any effect on the incidence and etiology of catheter‐related bacteremia (CRB). This study was carried out over a 5‐year period in a single center, where, in the first 2½ years, the exit sites were cleansed with betadine at every hemodialysis session and then covered with a transparent dressing (pre‐Biopatch ® Era). During the next 2½ years, Biopatch ® was applied to the exit site once a week after cleansing with betadine, and then covered with a transparent dressing (Biopatch ® Era). The application of Biopatch ® significantly decreased the incidence of exit site infections (ESI) (P<0.05). However, there was no difference in the incidence of CRBs or their microbiological distribution. The improved ESI rate had no effect on the overall catheter survival time. The antimicrobial sensitivities of the Gram‐positive microorganisms were statistically different for the 2 different types of infections (P<0.05). In conclusion, even though Biopatch ® is effective in decreasing the incidence of ESI, it has no effect on the incidence of CRB, the etiology of CRB, or the overall catheter survival time. The distinct difference between the antimicrobial sensitivities of the ESI and CRB suggests that they are not a spectrum of the same pathogenesis. These preliminary data support the intraluminal pathogenesis of CRB, rather than the exit site as a possible entry point for the extraluminal route.