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The incidence of catheter-related bloodstream infection can be reduced by implementing education-based programs and so-called central-line bundles, that emphasize the importance of hand hygiene, maximal barrier precautions upon insertion, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity.657 For detailed instructions on catheter care, the reader is referred to published guidelines.640,641,664,665 These guidelines also recommend not using dialysis catheters for applications other than RRT, except under emergency circumstances.641
A recent meta-analysis of five RCTs confirmed that topical antibiotics (mainly mupirocin) reduce the risk of bacteremia, exit-site infection, need for catheter removal, and hospitalization for infection in ESRD patients.682 The majority of the catheters in the included studies were tunneled. However, the CDC, National Health Service, and Infectious Diseases Society of America guidelines strongly recommend against topical antibiotic ointment for the care of CVC, because of their potential to promote fungal infections and antimicrobial resistance.641,664,665 For patients with AKI that are treated in an ICU, it seems reasonable to follow this last recommendation. No recommendations can be given for AKI patients that are treated outside an ICU.
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