Kidney Med

Prophylactic antibiotics before dialysis catheter insertion show no early infection benefit

August 14, 2025

Routine administration of prophylactic systemic antibiotics before tunneled hemodialysis catheter insertion wasn't associated with a reduction in early catheter-related bloodstream infections. These findings support a restrictive approach to prophylactic antibiotic use in this setting, aligning with antibiotic stewardship principles and minimizing unnecessary exposure.

Study details: This nationwide cohort study analyzed data from the REDUCCTION trial, including adults undergoing incident tunneled hemodialysis catheter insertion at 37 Australian nephrology services between December 2016 and March 2020. Services were categorized by their policy on systemic prophylactic antibiotic use prior to catheter insertion, as determined by a prestudy survey. Primary outcome was the rate of hemodialysis catheter-related bloodstream infection (HDCRBSI) within 14 days, adjudicated by a blinded panel using modified Infectious Diseases Society of America criteria. Multilevel logistic regression was used to compare outcomes.

Results: Among 1,196 catheters inserted at antibiotic-using services, 0.3% developed HDCRBSI and 0.8% required infectious removal within 14 days. In non-antibiotic-using services (5,027 catheters), 0.8% developed HDCRBSI and 0.8% required infectious removal. There was no statistically significant difference in early HDCRBSI rates between groups in either unadjusted (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.15–1.17) or adjusted analyses (adjusted OR, 0.59; 95% CI, 0.20–1.80).

Source:

Lazarus B; REDUCCTION investigators, et al. (2025, June 2). Kidney Med. Prophylactic Antibiotics Before Insertion of Tunneled Hemodialysis Catheters: A Nationwide Cohort Study. https://pubmed.ncbi.nlm.nih.gov/40740726/