Mokrzycki MH et al. (2006) An interventional controlled trial comparing 2 management models for the treatment of tunneled cuffed catheter bacteremia: a collaborative team model versus usual physician-managed care. Am J Kidney Dis 48: 587–595

Bacteremia is a major cause of morbidity and mortality in patients with tunneled cuffed catheters (TCCs), but management of this complication varies widely among nephrologists. Mokrzycki et al. compared two different management models, the collaborative team model—in which an infection manager (a registered nurse) works closely with nephrologists and dialysis staff to manage TCC-related bacteremia on the basis of the available guidelines—and the physician-managed model.

During the first 6 months of the study, baseline data were collected from seven outpatient long-term hemodialysis centers regarding physician-managed episodes of TCC-associated bacteremia. After 6 months, four centers were randomly assigned to collaborative-team management and three centers were assigned the physician-managed model.

In total, 223 first episodes of TCC-associated bacteremia were included in the study: 57 episodes that occurred during the 6-month prerandomization observation period and 166 episodes that occurred during the subsequent 2-year postrandomization period (55 episodes in physician-managed patients, and 111 episodes in patients managed by collaborative teams). Patients in whom TCC-related bacteremia was managed by a collaborative team were significantly less likely than those in physician-managed centers to experience recurrent bacteremia with the same organism (P = 0.015) or septic death (P = 0.047). Collaborative-team management of TCC-associated bacteremia was also associated with a 45% decrease in the use of TCC salvage in the postrandomization period compared with the observation period, and was associated with improvements in antibiotic selection, duration of administration and dosing.