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  • Title: Hemodialysis catheter-related bacteremia in children: increasing antibiotic resistance and changing bacteriological profile.
    Author: Araya CE, Fennell RS, Neiberger RE, Dharnidharka VR.
    Journal: Am J Kidney Dis; 2007 Jul; 50(1):119-23. PubMed ID: 17591531.
    Abstract:
    BACKGROUND: Catheter-related infections limit catheter survival. The success of antimicrobial therapy for the treatment of patients with hemodialysis catheter-related bacteremia (HD-CRB) depends on the infectious organisms. We determined whether the rate of positive blood culture results per tunneled catheter-days, the spectrum of bacterial isolates, and their antibiotic susceptibility changed over time in our pediatric dialysis unit. METHODS: Data were collected retrospectively for all positive blood culture results from long-term hemodialysis patients in our pediatric unit from July 1990 to July 1995 (period A) and July 2000 to July 2005 (period B). RESULTS: Rates of HD-CRB were similar between periods A and B (2.1 versus 2.2/1,000 catheter-days). In period A, 33% of isolates were coagulase-positive staphylococci, with Staphylococcus aureus accounting for 72% of these. In period B, the most common organism was Staphylococcus epidermidis (28%), whereas coagulase-positive staphylococci were identified in only 17%. There was a larger number of gram-positive bacilli in period B (20%) compared with period A (4%). A significant decrease in susceptibility to penicillins (40% to 5%; P = 0.007) and cephalosporins (58% to 21%; P = 0.04), but not aminoglycosides, was noted for gram-positive bacteria. There was no significant change in susceptibility of gram-negative bacteria to cephalosporins and aminoglycosides in either period. CONCLUSION: Both types of organism and antibiotic sensitivity patterns have changed over time. Based on these data, we changed our empiric antibiotic combination for HD-CRB to vancomycin plus an aminoglycoside.
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