{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:41:26Z","timestamp":1787319686176,"version":"build-2736575974"},"reference-count":87,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>Tunneled central venous catheters (CVC) are essential vascular access for many maintenance hemodialysis(HD) patients, yet catheter-related bloodstream infections (CRBSI) remain a persistent complication driven by biofilm formation and multidrug-resistant organisms, creating a clinical dilemma between source control (catheter removal) and vascular access preservation. This narrative review synthesizes current evidence across HD-CRBSI epidemiology, pathogenesis, prevention, treatment, and future directions, and provides an evidence-based, decision-oriented management framework. Key contributions include: systematic distinction between extraluminal (skin \u2192 cuff \u2192 bloodstream) and intraluminal (hub contamination) routes of infection; an HD-specific pathogen profile establishing Gram-positive predominance (approximately 64% of cases, with coagulase-negative staphylococci accounting for approximately 32%); a structured clinical classification differentiating uncomplicated versus complicated CRBSI and exit-site, tunnel, and systemic infections; explicit criteria for catheter salvage (hemodynamically stable patients with uncomplicated CRBSI caused by low-virulence pathogens, mandatory clinical and microbiological reassessment at 48\u201372 hours, and documented clearance of bacteremia) versus mandatory catheter removal (Staphylococcus aureus, Pseudomonas aeruginosa, Candida spp., tunnel infection, septic shock, or persistent bacteremia &amp;gt;72 hours); systematic integration of antimicrobial lock therapy into the salvage pathway, supported by HD-specific evidence including the LOCK-IT-100 trial; prioritization of standard-of-care prevention practices (mandatory catheter hub disinfection, standardized aseptic connection\/disconnection protocols, staff training with care bundles) over experimental strategies; and identification of key research priorities including standardized CRBSI surveillance methodologies, prospective validation of AI-assisted diagnostic tools, and rigorous evaluation of next-generation preventive technologies.<\/jats:p>","DOI":"10.3389\/fcimb.2026.1822898","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:41:08Z","timestamp":1780378868000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comprehensive management of hemodialysis catheter-related bloodstream infections: a narrative review"],"prefix":"10.3389","volume":"16","author":[{"given":"Yiran","family":"Ge","sequence":"first","affiliation":[{"name":"Graduate School of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Graduate School of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojie","family":"He","sequence":"additional","affiliation":[{"name":"Graduate School of Hebei Medical University","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Graduate School of Chengde Medical University","place":["Chengde, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Baoding No. 1 Central Hospital of Hebei Medical University","place":["Baoding, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B67","doi-asserted-by":"publisher","first-page":"18003","DOI":"10.1038\/s41598-022-21979-7","article-title":"Patterns of microbial resistance in bloodstream infections of hemodialysis patients: A cross-sectional study from Palestine","volume":"12","author":"Abutaha","year":"2022","journal-title":"Sci. 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