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QJM Advance Access originally published online on September 10, 2007
QJM 2007 100(10):667; doi:10.1093/qjmed/hcm082
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© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Response

P.C. Thomson

Renal Unit
Glasgow Royal Infirmary
Glasgow
UK

email: peter.thomson{at}northglasgow.scot.nhs.uk

Sir,

We thank Dr Diskin for his comments. We can bring clarity to many of his queries regarding other previously reported risk factors for sepsis.

Firstly, we have since evaluated serum calcium and found no significant association with bacteraemia in this cohort. None of our cohort had evidence of active catheter exit site infection, or a history of bacteraemia in the month prior to observation. Accurate and objective data for the period prior to this were not available to us. Data regarding peripheral atherosclerosis and thrombolytic catheter infusions were also not available to us, and therefore these variables could not be assessed.

We acknowledge that factors such as recent hospitalization and longer catheter survival time are established risk factors for bacteraemia, and we are now in the midst of a detailed prospective study of risk factors for catheter-related bacteraemia which aims to incorporate them.

Finally, we would like to make clear that surveillance blood cultures were not taken in this study. Blood cultures were only taken when bacteraemia was clinically suspected, thus conforming to the recommendation made by Nielsen et al.1 as cited by Dr Diskin.

We concur that a major contributor to the development of catheter-related bacteraemia is the presence of biofilm. There is growing opinion that this offers a potentially valuable preventative and therapeutic target. We agree that future research should be concentrated on targets such as this to limit the significant burden of infection-related disease suffered by this vulnerable population.

References

1. Nielsen J, Kolmos HJ, Rosdahl VT. Poor value of surveillance cultures for prediction of septicaemia caused by coagulase-negative staphylococci in patients undergoing haemodialysis with central venous catheters. Scand J Infect Dis (1998) 30:569–72.[CrossRef][Web of Science][Medline]


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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
100/10/667    most recent
hcm082v1
Right arrow Alert me when this article is cited
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Right arrow Articles by Thomson, P.C.
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