Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach

[EN] [Background and objective] Tunneled catheters (TC) have become an essential vascular access for hemodialysis (HD), despite their association with increased morbidity and mortality, particularly due to infections. Existing studies assessing the optimal combination of prophylactic measures to pre...

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Autores: Almenara-Tejederas, Marina, López-de la Torre Molina, Águeda, Moyano Franco, María Jesús, Cueto, Marina de, Rodríguez-Baño, Jesús, Salgueira Lazo, Mercedes
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Consejo Superior de Investigaciones Científicas (CSIC)
Repositorio:DIGITAL.CSIC. Repositorio Institucional del CSIC
OAI Identifier:oai:digital.csic.es:10261/422688
Acceso en línea:http://hdl.handle.net/10261/422688
https://api.elsevier.com/content/abstract/scopus_id/105028790380
Access Level:acceso abierto
Palabra clave:Bloodstream infection
Tunneled catheter
Kidney disease
Hemodialysis
Mortality
Bacteriemia
Catéter tunelizado
Enfermedad renal
Hemodiálisis
Mortalidad
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oai_identifier_str oai:digital.csic.es:10261/422688
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
Bacteriemias asociadas a cateter tunelizado: un enfoque basado en resultados a largo plazo
title Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
spellingShingle Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
Almenara-Tejederas, Marina
Bloodstream infection
Tunneled catheter
Kidney disease
Hemodialysis
Mortality
Bacteriemia
Catéter tunelizado
Enfermedad renal
Hemodiálisis
Mortalidad
title_short Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
title_full Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
title_fullStr Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
title_full_unstemmed Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
title_sort Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approach
dc.creator.none.fl_str_mv Almenara-Tejederas, Marina
López-de la Torre Molina, Águeda
Moyano Franco, María Jesús
Cueto, Marina de
Rodríguez-Baño, Jesús
Salgueira Lazo, Mercedes
author Almenara-Tejederas, Marina
author_facet Almenara-Tejederas, Marina
López-de la Torre Molina, Águeda
Moyano Franco, María Jesús
Cueto, Marina de
Rodríguez-Baño, Jesús
Salgueira Lazo, Mercedes
author_role author
author2 López-de la Torre Molina, Águeda
Moyano Franco, María Jesús
Cueto, Marina de
Rodríguez-Baño, Jesús
Salgueira Lazo, Mercedes
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Almenara-Tejederas, Marina [0000-0001-7123-5147]
Rodríguez-Baño, Jesús [0000-0001-6732-9001]
Salgueira Lazo, Mercedes [0000-0002-4695-1149]
Consejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72]
dc.subject.none.fl_str_mv Bloodstream infection
Tunneled catheter
Kidney disease
Hemodialysis
Mortality
Bacteriemia
Catéter tunelizado
Enfermedad renal
Hemodiálisis
Mortalidad
topic Bloodstream infection
Tunneled catheter
Kidney disease
Hemodialysis
Mortality
Bacteriemia
Catéter tunelizado
Enfermedad renal
Hemodiálisis
Mortalidad
description [EN] [Background and objective] Tunneled catheters (TC) have become an essential vascular access for hemodialysis (HD), despite their association with increased morbidity and mortality, particularly due to infections. Existing studies assessing the optimal combination of prophylactic measures to prevent TC-related infections are limited by small sample sizes and short follow-up periods. The objectives of this study were to describe the clinical and demographic characteristics of patients with TC in our healthcare area, determine the incidence and etiology of TC-related bloodstream infections (TC-BSI), and analyze the impact of pre-implantation prophylactic measures and patient survival over a long-term follow-up.
publishDate 2026
dc.date.none.fl_str_mv 2026
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
http://purl.org/coar/resource_type/c_6501
Publisher's version
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10261/422688
https://api.elsevier.com/content/abstract/scopus_id/105028790380
url http://hdl.handle.net/10261/422688
https://api.elsevier.com/content/abstract/scopus_id/105028790380
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv The underlying dataset has been published as supplementary material of the article in the publisher platform at DOI https://doi.org/10.1016/j.nefroe.2026.501396
https://doi.org/10.1016/j.nefroe.2026.501396
Sí
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier España
Sociedad Española de Nefrología
publisher.none.fl_str_mv Elsevier España
Sociedad Española de Nefrología
dc.source.none.fl_str_mv reponame:DIGITAL.CSIC. Repositorio Institucional del CSIC
instname:Consejo Superior de Investigaciones Científicas (CSIC)
instname_str Consejo Superior de Investigaciones Científicas (CSIC)
reponame_str DIGITAL.CSIC. Repositorio Institucional del CSIC
collection DIGITAL.CSIC. Repositorio Institucional del CSIC
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling Catheter-related bloodstream infections in tunneled catheters: a long-term outcomes-based approachBacteriemias asociadas a cateter tunelizado: un enfoque basado en resultados a largo plazoAlmenara-Tejederas, MarinaLópez-de la Torre Molina, ÁguedaMoyano Franco, María JesúsCueto, Marina deRodríguez-Baño, JesúsSalgueira Lazo, MercedesBloodstream infectionTunneled catheterKidney diseaseHemodialysisMortalityBacteriemiaCatéter tunelizadoEnfermedad renalHemodiálisisMortalidad[EN] [Background and objective] Tunneled catheters (TC) have become an essential vascular access for hemodialysis (HD), despite their association with increased morbidity and mortality, particularly due to infections. Existing studies assessing the optimal combination of prophylactic measures to prevent TC-related infections are limited by small sample sizes and short follow-up periods. The objectives of this study were to describe the clinical and demographic characteristics of patients with TC in our healthcare area, determine the incidence and etiology of TC-related bloodstream infections (TC-BSI), and analyze the impact of pre-implantation prophylactic measures and patient survival over a long-term follow-up.[EN] [Material and methods] We conducted a retrospective study including all patients with a TC implanted between 2005 and 2019 in a tertiary care hospital. Catheter implantation was performed by nephrologists following a protocol developed in collaboration with the Infectious Diseases Department. The protocol emphasized three main measures: screening and treatment of Staphylococcus aureus carriers, chlorhexidine bathing prior to the procedure, and antibiotic prophylaxis. We collected clinical-demographic variables, catheter-related data, and details of TC-BSI episodes. Patients were followed from the time of TC insertion until the end of the study (December 31, 2020), loss to follow-up, or death.[EN] [Results] Over the 14-year study period, 462 TCs were implanted in 381 patients [179 (55.1%) male; median age 67 (IQR 55–74) years; 154 (47.4%) with diabetes mellitus, 292 (89.9%) with hypertension, and 135 (41.5%) with cardiovascular disease]. The internal jugular vein was the most common site of insertion (275, 84.6%). Two types of catheters were predominantly used: Palindrome® (192, 59.1%) and Hemoglyde® (102, 31.4%). A total of 85 TC-BSI episodes were recorded (0.36 per 1,000 TC-days). The majority (71, 83.4%) were caused by Gram-positive organisms: Staphylococcus epidermidis (36, 42.4%) and S. aureus (24, 28.0%), including three methicillin-resistant strains. Over 80% of infections occurred after six months of catheter placement. Only four (4.7%) infections occurred within the first 30 days. During follow-up, 177 patients (54.4%) died. The most frequent cause of death was infection (55, 31.1%), although only seven deaths occurred following a TC-BSI (2.1% of the study population).[EN] [Conclusions] The implementation of a dedicated protocol for TC implantation was associated with a low incidence of TC-BSI. These infections tended to present late and were predominantly caused by S. epidermidis, a less virulent organism than S. aureus. Among the preventive measures, systematic screening and decolonization of nasal S. aureus carriers significantly reduced the incidence of TC-BSI caused by this pathogen, with no observed increase in methicillin-resistant strains over the long-term follow-up. In our cohort, TC use was associated with low TC-BSI–related mortality and did not negatively impact overall five-year survival. TCs may be a valid and safe option for selected patients in whom arteriovenous fistula creation is not feasible.[ES] [Antecedentes y objetivo] El catéter tunelizado (CT) se ha convertido en un acceso vascular indispensable para hemodiálisis (HD), a pesar de su mayor morbimortalidad, sobre todo infecciosa. Los estudios disponibles que analizan la combinación óptima de medidas profilácticas para evitar la infección relacionada con CT son limitados, con tamaños muestrales pequeños y periodos de seguimiento limitados. Los objetivos de nuestro estudio fueron describir características clinicodemográficas de los pacientes con CT en nuestra área, determinar la incidencia y etiología de las bacteriemias relacionadas con CT (BRC) y analizar el impacto de las medidas de profilaxis previas a la implantación del CT y la supervivencia de este grupo de pacientes en un largo periodo de tiempo.[ES] [Material y método] Estudio retrospectivo en el que se incluyeron todos los pacientes con CT implantado desde 2005 hasta 2019 en un área hospitalaria de un hospital de tercer nivel. La implantación fue realizada por nefrólogos, siguiendo un protocolo consensuado con el Servicio de Enfermedades Infecciosas en que destacan tres medidas: despistaje y tratamiento de portadores Staphylococcus aureus, baño con clorhexidina previo al procedimiento y profilaxis antibiótica. Se registraron variables clinicodemográficas, variables relacionadas con el CT y el episodio de BCR. El seguimiento se realizó desde la inserción del CT hasta fecha de finalización del estudio (31/12/2020), pérdida de seguimiento o exitus.[ES] [Resultados] Durante los 14 años de estudio, se implantaron 462 CT en 381 pacientes [179 (55,1%) eran varones, mediana de edad de 67 (55–74) años; 154 (47,4%) con diabetes mellitus, 292 (89,9%) hipertensos, 135 (41,5%) tenían enfermedad cardiovascular]. El CT se canalizó en la vena yugular interna en 275 (84,6%). Se emplearon principalmente dos tipos de CT: Palindrome® (192, 59,1%) y Hemoglyde® (102, 31,4%). Se registraron 85 BRC (0,36 por 1.000 días de CT). La mayoría de BRC (71, 83,4%) fueron causadas por organismos grampositivos: Staphylococcus epidermidis (36, 42,4%) y S. aureus (24, 28,0%), con 3 casos de cepas meticilín-resistentes. Más del 80% de las BRC se detectaron a partir del 6 mes de implantación. Solo 4 (4.7%) BRC ocurrieron en los primeros 30 días. Durante el seguimiento, 177 (54,4%) pacientes fallecieron. La causa de exitus más frecuente fue infecciosa (55, 31,1%), aunque solo siete fallecieron tras la detección de una BRC (2,1% de nuestra población de estudio).[ES] [Conclusiones] La implementación de un protocolo específico para la implantación de CT se asoció a una baja incidencia de BRC. Estas infecciones se caracterizaron por una aparición tardía y estar causadas predominantemente por S. epidermidis, un microorganismo menos virulento que S. aureus. Entre las medidas adoptadas, el cribado sistemático y la descolonización de portadores nasales de S. aureus contribuyeron a reducir significativamente las BRC causadas por este patógeno, sin observarse un aumento en la proporción de cepas meticilín-resistentes en un largo período de seguimiento. En nuestra cohorte, el uso de CT se asoció a una baja mortalidad atribuible a BRC y no mostró un impacto negativo relevante sobre la supervivencia global a cinco años. Los CT pueden ser una opción válida y segura en determinados perfiles de pacientes en los que la creación de una fístula arteriovenosa es dificultosa.This research has not received specific support from public sector agencies, the commercial sector or nonprofit entities.Peer reviewedElsevier EspañaSociedad Española de NefrologíaAlmenara-Tejederas, Marina [0000-0001-7123-5147]Rodríguez-Baño, Jesús [0000-0001-6732-9001]Salgueira Lazo, Mercedes [0000-0002-4695-1149]Consejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72]202620262026info:eu-repo/semantics/articlehttp://purl.org/coar/resource_type/c_6501Publisher's versioninfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://hdl.handle.net/10261/422688https://api.elsevier.com/content/abstract/scopus_id/105028790380reponame:DIGITAL.CSIC. Repositorio Institucional del CSICinstname:Consejo Superior de Investigaciones Científicas (CSIC)InglésThe underlying dataset has been published as supplementary material of the article in the publisher platform at DOI https://doi.org/10.1016/j.nefroe.2026.501396https://doi.org/10.1016/j.nefroe.2026.501396Síinfo:eu-repo/semantics/openAccessoai:digital.csic.es:10261/4226882026-05-22T06:33:51Z
score 15,811543

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