Successful Unconventional Treatment of Serratia Marcescens Exit-Site Infection in a Central Venous Catheter for Hemodialysis: A Case Report

Posted on Scarica PDF

Sara Morales Palomares

DOI: 10.69097/41-06-2024-06

Silvia Cappelletti¹, Sara Morales Palomares2, Stefano Mancin3, Marco Sguanci4

1 Department of Nephrology and Dialysis, Sant’Anna Hospital, Territorial Social Health Company Lariana, Como, Italy
2 Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, Rende, Italy
3 Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Viale Montpellier, 1- 00128 Rome, Italy
4 A.O. Polyclinic San Martino Hospital, Genova

Corresponding author:
Sara Morales Palomares RN, PhD,
Department of Pharmacy, Health and Nutritional Sciences (DFSSN)
University of Calabria, Rende, Italy
Phone: +39 3404249439
Mail: sara.morales@unical.it

 

Abstract

Introduction. Central Catheter-related infections and biofilm formation are significant issues in the context of nosocomial infections that increase resistance to conventional therapies.
Methodology. This case report describes an unconventional treatment for a Serratia Marcescens Central Venous Catheter infection in a hemodialysis patient through the combination of polyguanide and betaine. Clinical evaluations were conducted using the Visual Exit-Site Score and culture swabs.
Results. After the first four treatment sessions there was a significant reduction in redness and pain (VES=1); the culture swab at the end of treatment was negative.
Conclusions. The results of this case report encourage further research on the effectiveness of non-antibiotic treatments.

Keywords: Exit-Site infection, Central Venous Catheter, Serratia Marcescens, Polyguanide, Betaine

Introduction

The increasing global incidence of chronic kidney disease (CKD) [1] underscores the importance of hemodialysis as a life-saving replacement therapy. In this context, the use of central venous catheters (CVCs) introduces significant risks, including the onset of infections at the exit site [2].

These infections, often caused by resistant pathogens like Serratia Marcescens, pose major challenges, affecting patients’ quality of life and prognosis [3, 4].

Catheter-related infections (CRIs) are a significant issue in healthcare, with biofilms providing microorganisms a protective environment, increasing resistance to conventional therapies. Studies show that 50-70% of microbial infections involve biofilms emphasizing the need for effective treatments [5]. As microbial resistance rises, researching alternatives to traditional antibiotics is crucial [6]. This case report outlines the phases and management of an innovative treatment for a Serratia Marcescens infection in a hemodialysis patient using polyguanide and betaine. This promising approach aims to enhance current clinical practices in managing CVC infections and offers a new strategy for CRIs caused by Serratia Marcescens.

Read More

Thrombosis in Hemodialysis Tunnelled Central Venous Catheters: From Pathogenesis to Therapeutic Strategies

Posted on Scarica PDF

Francesca Bagagli

DOI: 10.69097/41-05-2024-05

Francesca Bagagli1, Simone Corciulo2, Pasquale Libutti2, Carlo Lomonte2, Vincenzo Montinaro2,3

1 U.O.C. di Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePre-J), Università degli Studi di Bari “Aldo Moro”, Bari
2 U.O.C. di Nefrologia e Dialisi, Ospedale Generale Regionale “F. Miulli”, Acquaviva delle Fonti (BA)
3 Università LUM Giuseppe Degennaro, Dipartimento di Medicina e Chirurgia, Casamassima (BA)

Corrispondenza a:
Francesca Bagagli
U.O.C. di Nefrologia, Dialisi e Trapianto, Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePre-J), Università degli Studi di Bari “Aldo Moro”
Piazza Giulio Cesare, 11, Bari, Italia
Telefono: 0805593668
E-mail: f.bagagli95@gmail.com

 

Abstract

Central venous catheter-related thrombosis is a frequent non-infectious complication, typically associated with catheter dysfunction and hemodialysis inadequacy. Central venous catheters (CVCs) are categorized into non-tunnelled and tunnelled types, wherein the choice depends on patient’s clinical conditions and the diagnostic and therapeutic workup. Tunnelled CVCs (tCVCs) are sought whenever an arteriovenous fistula is unfeasible or as primary access in patients with poor prognosis.
Dysfunction is defined as the inability to maintain adequate blood flow within the prescribed dialytic session.
Amongst non-infectious complications causing tCVC malfunctioning, thrombosis is the most frequent, and it is further classified into intrinsic (being endoluminal, pericatheter or fibrin sleeve-associated thrombosis) and extrinsic forms (including mural and atrial thrombosis).
Diagnosis requires imaging tests like chest X-ray or abdominal X-ray, echocardiography, dynamic catheterography and computed tomography.
Pharmacological treatment involves use of local thrombolytic agents. In case of extrinsic thrombosis, systemic anticoagulation is mandatory, occasionally requiring tCVC replacement.
Prevention of thrombotic complications includes adequate positioning and appropriate use of the tCVC, with anticoagulant/antimicrobial-based locking solutions playing a crucial role in this context. In cases of extrinsic thrombosis, treatment options vary based on thrombus size, ranging from a conservative approach availing of systemic anticoagulation to surgical interventions like thrombectomy or thrombus aspiration, possibly associated with tCVC removal.
In conclusion, late dysfunction of tCVCs is primarily due to thrombosis, thus requiring diagnostic imaging and specific drug therapies. Prevention is crucial to minimize complications.

Keywords: Central venous catheter, thrombosis vascular accesses, hemodialysis

Sorry, this entry is only available in Italiano.

Introduzione

La trombosi del catetere venoso centrale (CVC), insieme alla stenosi venosa e alla disfunzione meccanica, rientra tra le complicanze non infettive, il più delle volte tardive, del CVC ed è associata a malfunzionamento, bassi flussi ematici e inadeguatezza dialitica [1]. Si tratta di una complicanza tra le più frequenti nella comune pratica clinica di emodialisi. Pertanto, compito essenziale del team degli accessi vascolari è quello di prevenire, riconoscere e trattare tempestivamente le cause del malfunzionamento, in particolare la trombosi del CVC, spesso associata ad eventi fatali. Il nefrologo utilizza due tipologie di CVC: i non tunnellizzati (ntCVC), detti anche cateteri temporanei, non cuffiati, il cui utilizzo è limitato a un massimo di 15 giorni dal posizionamento e i cateteri tunnellizzati (tCVC), cuffiati, adatti a un uso più prolungato in assenza di accessi vascolari alternativi. La scelta del tipo di catetere è determinata dalle condizioni cliniche generali del paziente e dalla valutazione prognostica effettuata in prima istanza. Generalmente, si ricorre al tCVC come accesso vascolare (AV) di scelta qualora non vi sia un patrimonio vascolare adeguato all’allestimento di una fistola arterovenosa (FAV) nativa o protesica, oppure come prima opzione in presenza di controindicazioni al confezionamento di un AV alternativo (e.g. scompenso cardiaco di grado severo) o nei casi in cui l’aspettativa di vita sia inferiore a un anno. Il ntCVC, invece, viene prevalentemente utilizzato nell’ambito del trattamento dell’insufficienza renale acuta, nei pazienti late referral in caso di urgenza all’avvio a terapia dialitica o, per brevi periodi, come bridge in attesa della maturazione dell’AV definitivo. Occorre ricordare che, come suggerito dalle linee guida KDOQI, i ntCVC devono essere tenuti in situ per un periodo di tempo non superiore alle due settimane a causa dell’elevato rischio di infezioni, specialmente se posizionati in vena femorale e in soggetti obesi [2]. In questa Review metteremo a fuoco gli aspetti patogenetici, clinici e terapeutici peculiari della trombosi correlata al tCVC per emodialisi.

Read More

Cost analysis of haemodialysis catheter related bloodstream infection through the DRG system, “on behalf of Project Group of Vascular Access of Italian Society of Nephrology”

Posted on Scarica PDF

Salvatore Mandolfo

Salvatore Mandolfo1, Milena Maggio1, Giacomo Forneris2, Franco Galli3

1 UOC di Nefrologia e dialisi – Ospedale Maggiore Lodi
2 UOC di Nefrologia e Dialisi – Centro di Ricerche di Immunopatologia e Documentazione Malattie Rare – Ospedale San Giovanni Bosco e Università di Torino
3 BEL – Bioengineering  Laboratories Cantù

Autore corrispondente:
Salvatore Mandolfo
UOC di Nefrologia e Dialisi – Ospedale Maggiore di Lodi
Viale Savoia 1
26900 Lodi
Telefono: 0371/372731
e-mail : mandolfo@alice.it

 

Abstract

Catheter related bloodstream infections (CRBSI) represent a complication that often requires hospitalization and the use of economic resources. In Italy, there is no literature that considers the costs of CRBSI for tunneled catheters (CVCt).

The aim of this work is to evaluate the relative costs of CRBSI through the DRG system.

From 2012 to 2017 we examined 2.257 hospital discharge forms, 358 of which relating to haemodialysis patients. Patients with CVCt (167), compared to FAVs (157), on average stay in hospital longer (10 vs. 8 days), entail higher costs (+8.5%) and higher admissions rate for infections (+114%). The incidence of CRBSI was 0.67 episodes per 1000 CVCt/days. CRBSI accounts for 23% of the cases of hospitalization of patients with CVCt and 5.2% of total hospitalization costs. Complicated CRBSI involve a 9% increase in average costs compared to simple ones, with patients staying in hospital three times longer. The cost of a CRBSI varies from €4,080 up to €14,800, with an average cost of €5,575. The costs calculated here are less than a third of that reported in American literature but this can be explained by the different reimbursement rates systems. The methodology of CRBSI costs through DRGs appears simple, and its main limit is the correct compilation of the discharge form. This is a reminder that discharge forms are an integral part of the medical record and can become important in recognizing the cost of the medical services provided.

Keywords: hospital costs, CRBSI, central venous catheter

Sorry, this entry is only available in Italiano.

Introduzione

Il catetere venoso centrale tunnellizzato (CVCt) rappresenta, dopo la fistola artero venosa, l’accesso vascolare più frequentemente utilizzato nei pazienti in emodialisi in Italia. Gli ultimi dati ufficiali riportano una prevalenza del 18.4% della popolazione (1), ma è verosimile ipotizzare che tale dato sia abbastanza sottostimato e che almeno un terzo della popolazione ne sia portatore.

Read More