Treatment of Infection of the Vascular Access - AV-fistulae

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2003

- Infections of a native fistula: antibiotics and rest, when septicaemia ligature if necessary (Practice tips)

Dialysis Guidelines.  Vascular access
13. Prevention and management of infection in synthetic grafts

CSN-Canada
2006

- Treat infections of primary AV fistulae as subacute bacterial endocarditis with 6 wk of antibiotic therapy. (Grade D)

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

EBPG-Europe
2002

- Local infection of AV fistula without fever and without bacteraemia: appropriate antibiotics for ≥ 2 wks (Level C)
- With fever and bacteraemia ≥ 4 wks (longer if metastatic infection), and puncture sites to be changed (Level C)
- Fistula resection required in case of infected thrombi and/or septic emboli (Level C)
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 B)
- Additional coverage for gram negatives including pseudomonas with third or fourth generation cephalosporins in severely ill and immunocompromised patients  (Level B)

Guidelines VI.4 Treatment of vascular access infection

KDOQI-US
2006

- Infections of primary AVFs are rare and should be treated as subacute bacterial endocarditis with 6 weeks of antibiotic therapy. Fistula surgical excision should be performed in cases of septic emboli. (Level B)

Guidelines for vascular access
5.7: Treatment of Fistula Complications - Infection

UK-Guidelines