VASCULAR ACCESS-RELATED INFECTIONS IN CHRONIC-HEMODIALYSIS PATIENTS - RECOMMENDATIONS FOR TREATMENT

Vascular access-related infections are a major cause of death and morbidity in chronic hemodialysis patients. The vascular access device is the primary site for most of bacteremic episodes, which have a high mortality rate. Staphylococci, mainly Staphylococcus aureus but also coagulase negative staphylococci are the predominant organisms causative of these infections. Acinetobacter, Pseudomonas aeruginosa and Candida are seldom responsible. The first choice therapy recommended for autogenous fistula (Brescia-type) related septicemia are combinations such as vancomycin + aminoglycoside or vancomycin + rifampicin, under antibiotic serum concentration monitoring. Alternatively, oxacillin + aminoglycoside and cefamandole + aminoglycoside might be used. Catheter and graft fistula related septicemia should benefit from the same antibiotic regimens. However, in these situations, withdrawal of the intravascular device is often mandatory.