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

Benjamin Lazarus; Sradha Kotwal; Martin Gallagher; Kathryn Higgins; Sarah Coggan; Nicholas A. Gray; Girish Talaulikar; Kevan R. Polkinghorne; REDUCCTION investigators

doi:10.1016/j.xkme.2025.101042

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

Journal article

Open access

Peer reviewed

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

Benjamin Lazarus, Sradha Kotwal, Martin Gallagher, Kathryn Higgins, Sarah Coggan, Nicholas A. Gray, Girish Talaulikar, Kevan R. Polkinghorne and REDUCCTION investigators

Kidney Medicine, Vol.7(8), pp.1-8

2025

DOI: https://doi.org/10.1016/j.xkme.2025.101042

PMID: 40740726

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Abstract

Antimicrobial

bloodstream

CVC

infection

prevent

renal failure

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.

Details

Title: Prophylactic Antibiotics Before Insertion of Tunneled Hemodialysis Catheters: A Nationwide Cohort Study
Authors: Benjamin Lazarus (Corresponding Author) - The George Institute for Global Health
Sradha Kotwal - The George Institute for Global Health
Martin Gallagher - The George Institute for Global Health
Kathryn Higgins - The George Institute for Global Health
Sarah Coggan - The George Institute for Global Health
Nicholas A. Gray - University of the Sunshine Coast, Queensland, UniSC Clinical Trials Centre
Girish Talaulikar - Australian National University
Kevan R. Polkinghorne - Monash University
REDUCCTION investigators (Research Group)
Publication details: Kidney Medicine, Vol.7(8), pp.1-8
Publisher: Elsevier BV
Date published: 2025
DOI: 10.1016/j.xkme.2025.101042
ISSN: 2590-0595
PMID: 40740726
Copyright note: © 2025 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Data Availability: The individual patient data generated in the trial can be shared in accordance with the trial’s data sharing policy and in accordance with the local regulatory and ethical approval for the trial. The study protocol and statistical analysis plan have been published.
Grants: REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION), 1103241, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Organisation Unit: UniSC Clinical Trials Centre; School of Health and Behavioural Sciences - Legacy
Language: English
Record Identifier: 991153711802621
Output Type: Journal article

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Collaboration types: Domestic collaboration
Web Of Science research areas: Urology & Nephrology

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