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Incidencia de bacteriemia en pacientes portadores de catéter permanente tunelizado para hemodiálisis

DOI: 10.4321/S1139-13752008000400006

Keywords: tunnelled catheter, catheter-related bacteriaemia, bacteriaemia incidence rate, haemodialysis.

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Abstract:

catheter-related bacteriaemia is one of the main complications increasing the risk of loss of the catheter or even death of the patient. the use of sealing of the catheter lumen with antibiotics or the use of topical mupirocin on the exit orifice of the catheter have been proven to reduce the incident of bacteriaemia; however, the most aseptic possible handling of the catheter is the main tool for reducing this incidence. goal: to assess the rate of incident of bacteriaeima in patients with permanent tunnelled haemodialysis catheters without the use of sealing with antibiotics or the use of mupirocin, and placing particular emphasis on asepsis during handling. all patients with tunnelled catheters between 1st january and 31st december 2007 were included. in total there were 17 patients, 4 men and 13 women with an average age of 71.3 (11.3) years. the protocol consisted of using as aseptic a field as possible, the use of gloves each time the catheter was handled, use of masks both by the handler and the patient and the disinfection of the tunnel exit orifice with chlorhexidine, and of both catheter connections at the start and finish of the session. at 31st december the prevalence of patients with tunnelled catheters was 38.5%. during the period studied, a total of 8 bacteriaemias occurred in a total of 4462 days of monitoring (incidence rate of 1.8 bacteriaemias/1000 catheter-days). four blood cultures were positive for staphylococcus epidermidis, 1 for corynebacterium, 1 for staphylococcus auricularis and 2 were negative. no other staphylococcus aureus bacteriaemia occurred, nor any other sign of infection of the exit orifice. conclusion: an aseptic as possible handling of the catheter reduces the risk of bacteriaemia related to the catheter without the need to use sealing with antibiotics or topical mupirocin.

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