Treatment of Infection of the Vascular Access – AV Grafts

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia

With graft infection use antibiotics, rest, and if necessary revision/excision; with septicaemia early surgical intervention and if necessary removal (Practice tips)

Dialysis Guidelines. Vascular Access.
13. Prevention and management of infections in synthetic grafts

CSN-Canada
2006

- Treat extensive infection of a dialysis AV graft with parenteral antibiotics and total graft resection. (Grade D)

Guideline Chapter 4 – Managing VA Complications
pdf: Pg 20 of 27

EBPG-Europe
November 2002

VI.4.2.
- Infected grafts 2-4 weeks IV antibiotics depending on bacteraemia and usually need for surgical intervention (Level B)
VI.4.4.
- Two separate blood cultures from peripheral vein before start antibiotics for all access related infection (Level A)
- Methicillin first choice Glycopeptide recommended in hospitals and countries with increased incidence of MRSA and in known MRSA carriers (Level )
- Additional coverage for gram negatives including pseudomonas in severely ill and immunocompromised patients with third and fourth generation cephalosporins (Level B)

VI.4 Treatment of vasular access infection

KDOQI-US
2006

Superficial infection of an AVG should be treated as follows:

• 6.9.1 Initial antibiotic treatment should cover both gram-negative and gram-positive microorganisms. (Level B)
• 6.9.1.1 Subsequent antibiotic therapy should be based upon culture results.
• 6.9.1.2 Incision and drainage may be beneficial.
• 6.9.2 Extensive infection of an AVG should be treated with appropriate antibiotic therapy and resection of the infected graft material.

Vascular Access:
6.9 Treatment of AV Complication-Infection

UK-Guidelines