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Dynamics of Hemodialysis Catheter Colonization by Coagulase-Negative Staphylococci

Published online by Cambridge University Press:  21 June 2016

Christoph A. Fux ,
Dominik Uehlinger ,
Thomas Bodmer ,
Sara Droz ,
Claudine Zellweger  and
Kathrin Mühlemann
Christoph A. Fux
Affiliation:
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Dominik Uehlinger
Affiliation:
Division of Nephrology and Hypertension, University Hospital, Bern, Switzerland
Thomas Bodmer
Affiliation:
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Sara Droz
Affiliation:
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Claudine Zellweger
Affiliation:
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Kathrin Mühlemann*
Affiliation:
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
*
Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3010 Bern, Switzerland. [email protected]
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Abstract

Objectives:

Catheter colonization is a necessary but poorly characterized step in the pathogenesis of catheter-related infections. Colonization dynamics of central venous hemodialysis catheters were studied with emphasis on coagulase-negative staphylococci (CoNS) and their population genetics, antibiotic resistance, and biofilm formation. The homogeneity of CoNS colony morphotypes was evaluated.

Design:

Prospective, longitudinal study during 1,158 catheter-days with microbiological analysis of skin swabs, weekly catheter blood and brush samples, and catheter tips.

Setting:

Hemodialysis unit of a university hospital.

Patients:

Twenty-six patients with 24 non-tunneled and 5 tunneled catheters.

Results:

Nineteen (65.5%) of the catheters became colonized, 17 by CoNS. CoNS colonization of the inner lumen was observed in 17.2% of the catheters and was first detectable after 3 weeks. Colonization of the outer surface occurred in 44.8% of the catheters within a minimum of 2 weeks. PFGE of 53 CoNS revealed 10 clones and 20 unique isolates. Isolates from clones were more frequent in catheter blood and brush cultures than were unique isolates (41% vs 15%), were resistant to more antibiotics (median, 7 vs 2), and tended to more often carry the icaA gene (64.1% vs 40%). Four (23.5%) of the catheters showed colonization with a mixture of CoNS based on PFGE. The time from catheter insertion to such mixed CoNS colonization was longer than that for colonization with one CoNS PFGE pattern only (42 vs 25 days).

Conclusions:

Colonization of hemodialysis catheters is dominated by multidrug-resistant, icaA-positive CoNS clones. Mixed CoNS colonization occurs, but is delayed, suggesting a process of sequential superinfection (Infect Control Hosp Epidemiol 2005;26:567-574).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 6 , June 2005 , pp. 567 - 574
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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