The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Nephrology (Carlton). 2019 Aug;24(8):827-834. doi: 10.1111/nep.13507. Epub 2019 Apr 29.
Dialysis catheter-associated infections (CAI) are a serious and costly burden on patients and the health-care system. Many approaches to minimizing catheter use and infection prophylaxis are available and the practice patterns in Australia and New Zealand are not known. We aimed to describe dialysis catheter management practices in dialysis units in Australia and New Zealand.
Online survey comprising 52 questions, completed by representatives from dialysis units from both countries.
Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 79% of the dialysis population in both countries. Nephrologists (including trainees) inserted non-tunnelled catheters at 60% and tunnelled catheters at 31% of units. Prophylactic antibiotics were given with catheter insertion at 21% of units. Heparin was the most common locking solution for both non-tunnelled (77%) and tunnelled catheters (69%), with antimicrobial locks being predominant only in New Zealand (80%). Eight different combinations of exit site dressing were in use, with an antibiotic patch being most common (35%). All units in New Zealand and 84% of those in Australia undertook CAI surveillance. However, only 51% of those units were able to provide a figure for their most recent rate of catheter-associated bacteraemia per 1000 catheter days.
There is wide variation in current dialysis catheter management practice and CAI surveillance is suboptimal. Increased attention to the scope and quality of CAI surveillance is warranted and further evidence to guide infection prevention is required.
透析导管相关感染（CAI）是患者和医疗保健系统的严重且代价高昂的负担。有许多方法可最大程度地减少导管使用和感染预防，而澳大利亚和新西兰的实践模式尚不清楚。我们旨在描述澳大利亚和新西兰透析单位的透析导管管理实践。
在线调查包括 52 个问题，由来自两国透析单位的代表完成。
在联系的 64 个单位中，有 48 个（75％）做出了回应（澳大利亚 43 个，新西兰 5 个），代表了两国透析患者的 79％。肾科医生（包括受训者）在 60％的单位中插入非隧道导管，在 31％的单位中插入隧道导管。在 21％的单位中，在插入导管时给予了预防性抗生素。肝素是最常见的非隧道（77％）和隧道导管（69％）的锁定溶液，只有在新西兰（80％）中，抗菌锁才占主导地位。有 8 种不同的出口部位敷料组合在使用中，抗生素贴剂最常见（35％）。新西兰的所有单位和澳大利亚的 84％的单位都进行了 CAI 监测。但是，只有 51％的单位能够提供其最近每 1000 个导管日导管相关菌血症的发生率。
目前的透析导管管理实践存在广泛的差异，CAI 监测并不理想。需要更加关注 CAI 监测的范围和质量，并需要进一步的证据来指导感染预防。
