Routine replacement of tunneled, cuffed, hemodialysis catheters eliminates paraspinal/vertebral infections in patients with catheter-associated bacteremia

Background: Management of tunneled, cuffed, central venous catheters in hemodialysis (HD) patients with bacteremia remains a challenge. Attempts to salvage the catheter with systemic antibiotics alone have been associated with increased risk of metastatic infectious complications. Methods: Retrospective case series of patients with infectious complications in a chronic dialysis unit, affiliated with a tertiary care university hospital. Results: Between 1996 and 1999, when we treated HD catheter-associated bacteremia with systemic antibiotics alone, we encountered a clustering of 8 cases of paraspinal/vertebral infections in a population of 162 patients. After changing our protocol, i.e., routine catheter exchange over a guide wire at ∼48 h, while on systemic antibiotic therapy, we did not encounter any new cases of paraspinal/vertebral infections over a 15-month period. Conclusion: Our experience suggests that routine exchange of tunneled, cuffed catheters over a guide wire in HD patients presenting with bacteremia may significantly reduce serious infectious complications, e.g., epidural abscess/vertebral osteomyelitis.