Hemodialysis catheter-related
bacteremia is a common clinical problem with several management options. We performed a systematic review and meta-analysis to determine cure proportions with systemic
antibiotics,
antibiotic lock
solution, and guidewire exchange. We searched databases and registries; conference proceedings from relevant medical societies; and article reference lists. Data regarding management approach, cure, follow-up, recurrence, complications, and microbiology were abstracted and pooled from 28 selected publications. Odds ratios (
ORs) and 95% confidence intervals (95% CIs) were calculated from a mixed effects logistic regression model. In total, 1596 patients with tunneled
hemodialysis catheter-related
bacteremia were divided into groups on the basis of treatment with systemic
antibiotics (n=697),
antibiotic lock
solution (n=546), or guidewire exchange (n=353).
Antibiotic lock
solution and guidewire exchange had similar cure proportions that were superior to systemic
antibiotics alone (OR, 2.08; 95% CI, 1.25 to 3.45; P<0.01 for
antibiotic lock
solution; OR, 2.88; 95% CI, 1.82 to 4.55; P<0.001 for guidewire exchange versus systemic
antibiotics). Cure proportions were highest for
coagulase-negative staphylococci followed by gram-negative rods and Staphylococcus aureus. Among S. aureus
infections, guidewire exchange led to a higher cure proportion than systemic
antibiotics or
antibiotic lock
solution (OR, 3.33; 95% CI, 1.17 to 9.46; P=0.02; OR, 4.72; 95% CI, 1.79 to 12.46; P=0.002, respectively). Thus, results of this study suggest that tunneled
hemodialysis catheter-related
bacteremia should be treated with either guidewire exchange or
antibiotic lock
solution. Future studies should address prospectively whether one strategy is better than the other overall and for specific pathogens.