CP-058 Analysis of changes in management of catheter related infections in haemodialysis after implementation of a protocol

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BackgroundManagement of catheter related infections (CRIs) depends on the severity, type of catheter and need to keep it. When it is documented, systemic antimicrobial therapy should be started, as antibiotics lock therapy if the central venous catheter (CVC) is not removed. We reviewed the management of CRIs in patients undergoing haemodialysis over 2 years and found that only 18.7% of patients were properly handled. We decided to develop a treatment protocol for this type of infections with the nephrology department.PurposeTo analyse changes in the management of CRIs in patients undergoing haemodialysis after implantation of a management protocol.Material and methodsAn observational and retrospective study was carried out over 6 months in patients undergoing haemodialysis in which intravenous antibiotic therapy was initiated after implementation of a CRI management protocol. The results were compared with the results obtained in a previous study on the implementation of this protocol. The following variables were recorded: sex, age, type of venous access, type of extracted sample (blood cultures, exudate catheter or other sample), microorganisms isolated, intravenous antibiotics used and antibiotic lock therapy in patients with CVC.Results24 requests for intravenous antibiotics for 18 patients were analysed. 66.6% were men, median age 68.9 years and 61.1% of patients had CVC. Blood culture samples were collected in 50% of patients and other samples obtained were urine culture (20.8%), wound exudates (20.8%) and catheter exit site exudates (12.5%). There was no catheter related bacteraemia because all blood cultures were negative. There were 10 positive results for the rest of the samples and Pseudomonas aeruginosa was the most common isolate (50%) followed by coagulase negative staphylococcus (20%). The most common treatment was vancomycin monotherapy (25%), followed by ceftazidime monotherapy (20.8%), a combination of both drugs (16.7%) and gentamicin (12.5%). Antibiotic lock therapy was performed in 70.8% of patients with CVC. Also, 12 pharmaceutical interventions about antibiotic selection, treatment duration or suspension because of negative results were made, and 66.7% were accepted.ConclusionResults have improved after implementation of a CRI management protocol, particularly antibiotic lock therapy (from 18.7% to 70.8%), although it is still necessary to reinforce the need for taking blood cultures in serious infection to discard CRIs.No conflict of interest

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