{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:12:47Z","timestamp":1789560767271,"version":"build-2803163510"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 2","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Vascular access-related infections are a significant cause of morbidity and mortality among patients on maintenance hemodialysis (MHD). In developing countries like Nigeria, the reliance on central venous catheters (CVCs) as a primary vascular access point increases the risk of catheter-related bloodstream infections (CRBSI). This report highlights the clinical management of CRBSI and the systemic constraints faced in resource-limited settings. The index case was a 49-year-old woman with end-stage renal disease (ESRD) secondary to diabetes mellitus, currently on MHD via a CVC, presented with a high-grade fever during a dialysis session. Clinical examination and positive blood cultures drawn from the dialysis tubing confirmed a CRBSI. No other focal source of infection was identified. Microbiological analysis identified the pathogen (consistent with common isolates like\n                    <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                    ). The patient was managed with a combination of topical and parenteral antibiotics tailored to the microbiogram. Following initial stabilization and antibiotic therapy, a catheter exchange was performed to eliminate the source of the infection.The patient showed clinical improvement with the resolution of fever and clearance of the bloodstream infection. However, the management process was complicated by significant local constraints, including the inability to monitor serum trough levels for antibiotic dosing, the high cost of specialized medications, and the limited availability of drugs effective against methicillin-resistant\n                    <jats:italic toggle=\"yes\">S. aureus<\/jats:italic>\n                    (MRSA). Catheter-related bloodstream infection remains a formidable complication for hemodialysis patients in Nigeria. While definitive treatment involving targeted antibiotics and catheter exchange is effective, there is an urgent need for improved access to affordable MRSA-active antibiotics and laboratory facilities for therapeutic drug monitoring to optimize patient outcomes.\n                  <\/jats:p>","DOI":"10.4103\/aam.aam_206_21","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T07:02:30Z","timestamp":1775545350000},"page":"S343-S346","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Gaps and Management Hurdles: Central Venous Catheter-related Infections in an End-stage Renal Disease Patient in Nigeria"],"prefix":"10.4103","volume":"25","author":[{"given":"Chimezie Godswill","family":"Okwuonu","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Federal Medical Centre, Umuahia and College of Medicine, Gregory University, Abia State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"R1-20260916","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.2215\/CJN.01320307","article-title":"Course of vascular access and relationship with treatment of anemia","volume":"2","author":"Portol\u00e9s","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"R2-20260916","first-page":"501957","article-title":"The enormity of chronic kidney disease in Nigeria: The situation in a teaching hospital in South-East Nigeria","author":"Ulasi","year":"2010","journal-title":"J Trop Med 2010"},{"key":"R3-20260916","first-page":"23","article-title":"Challenges of vascular access in a new dialysis centre \u2013 Uyo experience","volume":"7","author":"Ekpe","year":"2010","journal-title":"Pan Afr Med J"},{"key":"R4-20260916","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1177\/039139880602901006","article-title":"Practice pattern of hemodialysis vascular access in Maiduguri, Nigeria","volume":"29","author":"Nwankwo","year":"2006","journal-title":"Int J Artif Organs"},{"key":"R5-20260916","first-page":"p. 37","article-title":"Pattern of Haemodialysis Access Use at University College Hospital, Ibadan","author":"Raji","year":"2014","journal-title":"Astract Presented at the Conference of Nigerian Association of Nephrology, Owo\/Akure"},{"key":"R6-20260916","first-page":"7","article-title":"Changing pattern of vascular access use for maintenance haemodialysis in a tertiary hospital in Southern Nigeria","volume":"9","author":"Ojeh-Oziegbe","year":"2014","journal-title":"Trop J Nephrol"},{"key":"R7-20260916","doi-asserted-by":"crossref","first-page":"e70338","DOI":"10.1002\/hsr2.70338","article-title":"Catheter-related bloodstream infections among hemodialysis patients in Northern Tanzania: Insights from a single-centre retrospective study","volume":"8","author":"Costantine","year":"2025","journal-title":"Health Sci Rep"},{"key":"R8-20260916","doi-asserted-by":"crossref","first-page":"3145","DOI":"10.2147\/IDR.S409400","article-title":"Catheter-related blood stream infections and associated factors among hemodialysis patients in a tertiary care hospital","volume":"16","author":"Weldetensae","year":"2023","journal-title":"Infect Drug Resist"},{"key":"R9-20260916","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s12882-019-1332-z","article-title":"Staphylococcus aureus colonization in hemodialysis patients: A prospective 25 months observational study","volume":"20","author":"Scheuch","year":"2019","journal-title":"BMC Nephrol"},{"key":"R10-20260916","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1053\/j.ajkd.2007.04.014","article-title":"Treatment of dialysis catheter-related Staphylococcus aureus bacteremia with an antibiotic lock: A quality improvement report","volume":"50","author":"Maya","year":"2007","journal-title":"Am J Kidney Dis"},{"key":"R11-20260916","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1128\/AAC.00350-06","article-title":"Comparative activities of daptomycin, linezolid, and tigecycline against catheter-related methicillin-resistant Staphylococcus bacteremic isolates embedded in biofilm","volume":"51","author":"Raad","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"key":"R12-20260916","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jmii.2025.08.005","article-title":"High-dose daptomycin versus linezolid for the treatment of vancomycin-resistant Enterococcus faecium bloodstream infections: Role of pharmacodynamic target attainment","volume":"59","author":"Hwang","year":"2026","journal-title":"J Microbiol Immunol Infect"},{"key":"R13-20260916","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1186\/s12879-024-09927-4","article-title":"Effect of low versus high vancomycin trough level on the clinical outcomes of adult patients with sepsis or gram-positive bacterial infections: A systematic review and meta-analysis","volume":"24","author":"Chander","year":"2024","journal-title":"BMC Infect Dis"},{"key":"R14-20260916","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s12879-021-05858-6","article-title":"The monitoring of vancomycin: A systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing","volume":"21","author":"Tsutsuura","year":"2021","journal-title":"BMC Infect Dis"},{"key":"R15-20260916","doi-asserted-by":"crossref","first-page":"2393","DOI":"10.2147\/IDR.S184897","article-title":"Vancomycin trough level and loading dose","volume":"11","author":"Tuon","year":"2018","journal-title":"Infect Drug Resist"},{"key":"R16-20260916","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1186\/s12879-025-11400-9","article-title":"Association of vancomycin trough levels, AUC and AUC\/MIC ratios with clinical outcomes in patients with enterococcal bacteremia: A prospective cohort study","volume":"25","author":"Sel","year":"2025","journal-title":"BMC Infect Dis"},{"key":"R17-20260916","doi-asserted-by":"crossref","first-page":"e0214309","DOI":"10.1371\/journal.pone.0214309","article-title":"The association of vancomycin trough levels with outcomes among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections: Retrospective cohort study","volume":"14","author":"Yahav","year":"2019","journal-title":"PLoS One"},{"key":"R18-20260916","first-page":"444","article-title":"Two cases of vancomycin-intermediate Staphylococcus aureus isolated from joint tissue or wound","volume":"28","author":"Hong","year":"2008","journal-title":"Korean J Lab Med"},{"key":"R19-20260916","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1055\/s-0042-1758877","article-title":"Tunneled hemodialysis catheter insertion: Technical and clinical considerations","volume":"33","author":"Yaxley","year":"2023","journal-title":"Indian J Radiol Imaging"},{"key":"R20-20260916","first-page":"20584601221122421","article-title":"Tunneled hemodialysis catheter insertion: Above, within, or below the right atrium-Where is the tip?","volume":"11","author":"Auer","year":"2022","journal-title":"Acta Radiol Open"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_206_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:00:33Z","timestamp":1789560033000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_206_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":20,"journal-issue":{"issue":"Suppl 2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_206_21","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]},"assertion":[{"value":"2021-09-25","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}