Hemodialysis catheter-related bloodstream infections: A single-centre experience

Aim and objectives: In hemodialysis patients, catheter-related bloodstream infections (CRBSI) cause significant morbidity and mortality. We analyzed CRBSI incidence, associated factors, and the causative organisms’ spectrum. Methodology: Patients aged ≥18 years either on maintenance hemodialysis or with acute kidney injury having CRBSI (NKF-KDOQI criteria) were included in this prospective observational study and patients with other infections were excluded. Blood, catheter tip culture and antibiogram were analyzed. All patients were initially treated with antibiotics covering both gram-positive and gram-negative pathogens. Results: Of 921 catheters (882 patients) analyzed, 212 (23%) had CRBSI, of which 69(32.5%) and 143(67.5%) had possible CRBSI and probable CRBSI respectively. 131 (61.8%) were <60 years, 133 (62.7%) were males, 177 (83.5%) had diabetes, 141(66.5%) had leukocytosis and 172(81.1%) had positive procalcitonin. 193 (91%) had uncuffed catheters and 162 (76.4%) had jugular catheters. Our study showed that CRBSI incidence was 13.39/1000 catheter days, median catheter days, and median time to CRBSI was 40 and 17.2 days. Gram-positive coagulase-negative staphylococcus aureus (n=31; 44.9%) followed by extended-spectrum beta-lactamase (ESBL) enteric gram-negative organisms (n=30; 43.4%) were common isolates and remaining had fungal etiology (n=8; 11.7%). Conclusion: The incidence of CRBSI was high in our population. In culture-positive cases, gram-positive organisms contributed marginally higher than gram-negative organisms. Coagulase Negative Staphylococcus aureus (CONS) and ESBL enteric gram-negative organisms are the commonest isolates. More than two-thirds of patients with CRBSI had diabetes mellitus and leukocytosis at presentation.