ReviewFrontiers in cellular and infection microbiology2026
Comprehensive management of hemodialysis catheter-related bloodstream infections: a narrative review.
Review in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Tunneled central venous catheters (CVC) are essential vascular access for many maintenance hemodialysis(HD) patients, yet catheter-related bloodstream infections (CRBSI) remain a persistent complication driven by biofilm formation and multidrug-resistant organisms, creating a clinical dilemma between source control (catheter removal) and vascular access preservation. This narrative review synthesizes current evidence across HD-CRBSI epidemiology, pathogenesis, prevention, treatment, and future directions, and provides an evidence-based, decision-oriented management framework. Key contributions include: systematic distinction between extraluminal (skin → cuff → bloodstream) and intraluminal (hub contamination) routes of infection; an HD-specific pathogen profile establishing Gram-positive predominance (approximately 64% of cases, with coagulase-negative staphylococci accounting for approximately 32%); a structured clinical classification differentiating uncomplicated versus complicated CRBSI and exit-site, tunnel, and systemic infections; explicit criteria for catheter salvage (hemodynamically stable patients with uncomplicated CRBSI caused by low-virulence pathogens, mandatory clinical and microbiological reassessment at 48-72 hours, and documented clearance of bacteremia) versus mandatory catheter removal (Staphylococcus aureus, Pseudomonas aeruginosa, Candida spp., tunnel infection, septic shock, or persistent bacteremia >72 hours); systematic integration of antimicrobial lock therapy into the salvage pathway, supported by HD-specific evidence including the LOCK-IT-100 trial; prioritization of standard-of-care prevention practices (mandatory catheter hub disinfection, standardized aseptic connection/disconnection protocols, staff training with care bundles) over experimental strategies; and identification of key research priorities including standardized CRBSI surveillance methodologies, prospective validation of AI-assisted diagnostic tools, and rigorous evaluation of next-generation preventive technologies.
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