Prevalence of Catheter Related Blood Stream Infection among Patients on Maintenance Hemodialysis, Causative Organism and Catheter Outcome

Background: Hemodialysis (HD) patients are at risk of several causes of morbidity and mortality especially cardiovascular related complications and Infection. In patients on maintenance HD infection and sepsis are major hospitalization cause and the second most common cause of mortality. Objective: The aim of the current study is to investigate the incidence of catheter related blood stream infection among HD patients.
Patients and methods: A total of 161 patients on maintenance HD at Ain Shams University Hospital Dialysis Unit for at least 3 months prior to start of study, and followed up for 12 consecutive months.
Results: A total of 161 patients were included in our study; mean age was 55.2 (SD 17.1) years old, and mean follow up was 10.9 (SD 2.7) months. Patients were observed for 12 months on maintenance HD, 102 (63.4%) of the patients’ vascular access was arteriovenous fistula and 59 (36.6%) patients with dialysis catheter (tunneled or non-tunneled catheter). Patients older than 65 years old were independently associated with increased risk of CRBSI relative risk 1.13 (95%CI: 1.57-2.24) [P-value <0.001]. Prolonged of catheter indwelling was independently associated with higher CRBSI relative risk in patients with >12 months catheter indwelling time relative risk 1.75 (95%CI: 1.0-2.0) [P-value <0.001]. Diabetes is independently associated with higher relative risk of CRBSI 1.94 (95%CI: 1.15-3.26) [P-value <0.001]. Most common causative organism was gram-positive bacteria (65) %, followed by gram-negative bacteria (35%). gram negative CRBSI is independently associated with higher risk of catheter loss compared to gram positive organisms’ relative risk 5.18 (95%CI: 1.76-15.18) [P-value <0.001].
Conclusion: CRBSI is common among patients on maintenance hemodialysis maximizing prevention strategies and tailoring treatment approaches is vital for the reduction of rate of CRBSI and appropriate catheter management.