Conservative management of hemodialysis catheter-related infections feasibility and clinical outcomes

Authors

Zitouni, Samia; Temacini, Isma; Saidani, Messaoud

Citation

Arab J Nephrol Transplant. 2026;8(1):31–38.

Abstract

Background: Catheter-related infections in hemodialysis remain a major problem. Management strategies vary widely between catheter removal and conservative management. This study evaluates the feasibility and outcomes of a conservative catheter-preservation approach. Methods: This retrospective study, conducted over 20 months at Beni Messous University Hospital (Algiers), analyzed the management of 69 catheter-related infections occurring in patients undergoing hemodialysis via nontunneled central venous catheters. A local protocol was implemented consisting of conservative management for jugular catheter infections, while femoral catheters were systematically removed except in cases where no alternative vascular access was available. Conservative treatment was avoided in patients with hemodynamic instability, persistent fever beyond 72 h, or metastatic complications. Results: During the study, 365 central venous catheters were placed in 250 patients, with 69 developing infections. Patients were mainly young adults (mean age 50.6 years) with slight male predominance (50.7%) and frequent comorbidities such as diabetes or hypertension. Jugular access was used in 52.2% of cases, while nearly half required femoral insertion; over 72% remained in place more than 10 days. Among infected catheters, 53 (76.8%) were removed, including 24 jugular lines, while 16 (23.2%) were successfully preserved with complete resolution. Coagulase-negative staphylococci were most common (30.1%), followed by Staphylococcus aureus (18.8%). Systemic signs (fever, chills, C-reactive protein elevation, leukocytosis) were the only significant predictor of removal (P = 0.035). Conclusion: A risk-based strategy, preserving jugular catheters with local signs and removing high-risk cases, suggests catheter salvage may be a safe alternative to routine removal.

Full text (excerpt)

Conservative management of hemodialysis catheter-related infections feasibility and clinical outcomes Samia Zitouni¹, Isma Temacini², Messaoud Saidani³ ¹Department of Nephrology, Dialysis and Kidney Transplantation, Specialized Hospital of Bologhine, Algiers, ²Department of Nephrology, Dialysis and Kidney Transplantation, Mustapha Bacha University Hospital, Algiers, Algeria. Correspondence to Samia Zitouni, Assistant Professor of Nephrology, Department of Nephrology, Dialysis and Kidney Transplantation, Specialized Hospital for Organ and Tissue Transplantation, 09000, Blida, Algeria. Tel: 213772640677 E-mail: [email protected] Received 04 October 2025 Revised 21 October 2025 Accepted 01 November 2025 Published 01 May 2026 Arab Journal of Nephrology and Transplantation 2026, 8:31-38 Abstract Background Catheter-related infections in hemodialysis remain a major problem. Management strategies vary between catheter removal and conservative management. This study evaluates the feasibility and outcomes of a conservative catheter-preservation approach. Methods This retrospective study, conducted over 20 months at Beni Messous University Hospital (Algiers), analyzed the management

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The Arab Journal of Nephrology and Transplantation is the peer-reviewed open-access journal of ASNRT, published since 2008.

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