Prophylactic Antibiotics Before Insertion of Tunneled Hemodialysis Catheters: A Nationwide Cohort Study.

RATIONALE & OBJECTIVE: It is unknown whether administration of prophylactic systemic antibiotics immediately before tunneled catheter insertion can prevent early hemodialysis catheter-related bloodstream infections (HDCRBSI). We aimed to estimate the effect of systemic prophylactic antibiotics on early HDCRBSI.

STUDY DESIGN

An observational secondary analysis using data from the nationwide REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach trial.

SETTING & PARTICIPANTS: Adults with an incident hemodialysis catheter inserted in one of 37 Australian nephrology services from December 2016 to March 2020.

EXPOSURE

Service-wide policy of systemic prophylactic antibiotic use before tunneled catheter insertion determined by response to a prestudy survey.

OUTCOME

HDCRBSI within 14 days of catheter insertion, independently adjudicated by a blinded panel using modified Infectious Diseases Society of America criteria.

ANALYTICAL APPROACH

Multilevel logistic regression to compare outcomes among antibiotic-using and nonusing services.

RESULTS

Six services (900 patients) used prophylactic antibiotics, and 23 services (3,702 patients) did not. Among the 1,196 tunneled catheters that were inserted in antibiotic-using services, 4 (0.3%) had HDCRBSI and another 10 (0.8%) had infectious removal within 14 days of insertion. Among the 5,027 tunneled catheters inserted in nonantibiotic-using services, 40 (0.8%) had HDCRBSI and another 41 (0.8%) had infectious removal within 14 days. The odds of early HDCRBSI were not significantly different between antibiotic-using and nonusing services in the unadjusted (OR, 0.42; 95% CI, 0.15-1.17) or adjusted models (adjusted OR, 0.59; 95% CI, 0.20-1.80).

LIMITATIONS

Prophylactic systemic antibiotic use was determined at a service level and was not randomly assigned to individuals.

CONCLUSIONS

In Australia, less than 1% of tunneled catheters had confirmed HDCRBSI within 14 days of insertion. Routine administration of prophylactic antibiotics before insertion of tunneled cuffed catheters was not associated with a reduced occurrence of early HDCRBSI within 14 days.