An interventional controlled trial comparing 2 management models for the treatment of tunneled cuffed catheter bacteremia: a collaborative team model versus usual physician-managed care.

Abstract

BACKGROUND:

The management of tunneled cuffed catheter (TCC)-associated bacteremias varies among nephrologists. To determine whether patient outcomes after TCC-associated bacteremia can be improved by modifying the management model, we performed an interventional controlled trial comparing a collaborative team model, intervention (INT), with the usual physician-managed model, usual care (UC).

METHODS:

INT consisted of an infection manager who worked closely with nephrologists and dialysis staff and made treatment recommendations using the available published guidelines at the time of the study's conception (Dialysis Outcomes Quality Initiative guideline no. 26, 1997) and additional literature-based recommendations. Nephrologists made the final treatment decisions. TCC-associated bacteremia was physician managed in the UC group.

RESULTS:

Two hundred twenty-three episodes of TCC-associated bacteremia occurred in 7 outpatient hemodialysis units during the 2-year study period. The INT was associated with a significantly lower incidence of recurrent bacteremia with the same organism (INT, 6% versus UC, 18%; odds ratio, 0.28; 95% confidence interval, 0.09 to 0.8; P = 0.015) and death from sepsis (INT, 0% versus UC, 6%; P < 0.02). In INT units, there was a 45% decrease in the practice of TCC salvage (TCC not removed; P = 0.05). Antibiotic prescribing practices (final antibiotic selection, dose, and duration of therapy) were improved in INT units compared with UC units. By using multivariate analysis, the INT was associated with a 73% decrease in the combined outcome of recurrent bacteremia or septic death (P < 0.02).

CONCLUSION:

Implementation of a collaborative team model for the management of TCC-associated bacteremic episodes is associated with improvement in the quality of heath care delivery and patient outcomes.

• Authors: Michele Helene Mokrzycki, Meilin Zhang, Ladan Golestaneh, Jeffrey Laut, Stuart O Rosenberg
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 48 Issue 4 Pg. 587-95 (Oct 2006) ISSN: 1523-6838 [Electronic] United States
• PMID: 16997055 (Publication Type: Comparative Study, Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Bacteremia (drug therapy, etiology)
• Catheterization (adverse effects)
• Female
• Guideline Adherence
• Humans
• Kidney Diseases (therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Patient Care Team
• Physician-Patient Relations
• Prospective Studies
• Quality of Health Care
• Renal Dialysis (adverse effects, instrumentation)
• Staphylococcus aureus
• Treatment Outcome