Hemodialysis Catheter-Related Bacteremia in Children: Increasing Antibiotic Resistance and Changing Bacteriological Profile

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.