Prophylactic Antibiotics Before Insertion of Tunneled Hemodialysis Catheters: A Nationwide Cohort Study

TL;DR

A study in Australia found that giving antibiotics before inserting hemodialysis catheters did not significantly reduce early bloodstream infections.

Contribution

This nationwide observational study provides real-world evidence on the effectiveness of prophylactic antibiotics for preventing hemodialysis catheter infections.

Findings

Prophylactic antibiotics were not associated with a reduced occurrence of early HDCRBSI.

Less than 1% of tunneled catheters had confirmed HDCRBSI within 14 days of insertion.

The odds of early HDCRBSI were not significantly different between antibiotic-using and nonusing services.

Abstract

It is unknown whether administration of prophylactic systemic antibiotics immediately before tunneled catheter insertion can prevent early hemodialysis catheter-related bloodstream infections (HDCRBSI). We aimed to estimate the effect of systemic prophylactic antibiotics on early HDCRBSI.

An observational secondary analysis using data from the nationwide REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach trial.

Adults with an incident hemodialysis catheter inserted in one of 37 Australian nephrology services from December 2016 to March 2020.

Service-wide policy of systemic prophylactic antibiotic use before tunneled catheter insertion determined by response to a prestudy survey.

HDCRBSI within 14 days of catheter insertion, independently adjudicated by a blinded panel using modified Infectious Diseases Society of America criteria.

Multilevel logistic regression to compare outcomes among antibiotic-using and nonusing services.

Six services (900 patients) used prophylactic antibiotics, and 23 services (3,702 patients) did not. Among the 1,196 tunneled catheters that were inserted in antibiotic-using services, 4 (0.3%) had HDCRBSI and another 10 (0.8%) had infectious removal within 14 days of insertion. Among the 5,027 tunneled catheters inserted in nonantibiotic-using services, 40 (0.8%) had HDCRBSI and another 41 (0.8%) had infectious removal within 14 days. The odds of early HDCRBSI were not significantly different between antibiotic-using and nonusing services in the unadjusted (OR, 0.42; 95% CI, 0.15-1.17) or adjusted models (adjusted OR, 0.59; 95% CI, 0.20-1.80).

Prophylactic systemic antibiotic use was determined at a service level and was not randomly assigned to individuals.

In Australia, less than 1% of tunneled catheters had confirmed HDCRBSI within 14 days of insertion. Routine administration of prophylactic antibiotics before insertion of tunneled cuffed catheters was not associated with a reduced occurrence of early HDCRBSI within 14 days.

Millions of people worldwide with kidney failure rely on a central venous catheter to facilitate life-sustaining hemodialysis treatments. Unfortunately, catheters can lead to dangerous bloodstream infections, particularly during the first 2-weeks after insertion. It is unknown whether administration of prophylactic antibiotics before catheter insertion can prevent such infections, and real-world practice is mixed. We conducted a post-hoc analysis of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach trial and found that there was no statistically significant difference in the proportion of catheters that were affected by early bloodstream infection in prophylactic-antibiotic-using services (0.3% of 1,196 catheters) compared with nonusing services (0.8% of 5,027 catheters). More observational studies are warranted pending large, randomized trials.

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