A CLINICAL AND MICROBIOLOGICAL SPECTRUM OF CATHETER RELATED BLOOD STREAM INFECTION (CRBSI) AND ITS OUTCOMES IN CHRONIC KIDNEY DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS.

Introduction:

Chronic Kidney disease, with its high prevalence, morbidity and mortality, is an important public health problem. Each year, increasing numbers of patients reach the final stage of a renal disease and start a renal replacement therapy. An online survey among Indian nephrologists showed that more than three-quarters of patients started dialysis with uncuffed catheter, less than one-quarter started dialysis with fistula; and very few used grafts or tunnelled catheters. Catheter-related bloodstream infection (CRBSI) is one of the most feared consequences of hemodialysis catheter use due to its associates increased risk of morbidity and mortality. It has many complications in term of severe sepsis and septic shock, necessiting catheter removal and issue for new access for dialysis, excess health care expenditure and death. This study was conducted to assess clinical and microbiological spectrum of  CRBSI at tertiary care centre in India.

Methods:

This was a prospective observational cohort study conducted at Department of Nephrology, Medanta – The Medicity Hospital, Gurgaon. All patients who underwent tunneled/non-tunneled dialysis catheter insertion by nephrologist between January 2022 to June 2023 were recruited. Demographic, clinical, laboratory data, incidence, microbiological spectrum and factors affecting outcomes of CRBSI were noted. 

Results:

492 patients were recruited with mean age of 48.7 years, 280 were male and 212 females. 314 had non-tunneled catheter and 178 had tunneled catheter. An incidence of CRBSI was 2.62 per 1000 catheter days with more among those with non-tunneled catheters as compare to tunneled catheters. All patients presented with episodes of fever with 14/65 had shock at presentation. Among isolates, 47% (n=31) were gram negative, 42% (n=27) were gram positive, 8% (n=5) were polymicrobial and 3% (n=2) fungal. 14/31 (45%) among gram negative organisms were MDR isolates and 8/27 (30%) were MRSA among gram positives.  Catheter exchange were required in 21/25 (84%) and 9/40 (22.5%) in non-tunneled  and tunneled catheters group, respectively. Total 3/65 (4%) patients expired due to severe sepsis and shock at presentation. Presence of hypotension, increased duration of catheter use, higher Leucocyte count, higher procalcitonin, presence of MDR organisms were the factors for poor outcome. 

Conclusions:

Our study showed changing microbiological profile in terms of increased frequency of gram-negative organisms with increased isolation of MDR organisms. Proper antiseptic technique, prompt investigation and treatment for CRBSI is necessary to salvage the catheter and when patient is in severe sepsis, not responding to treatment, early removal of catheter along with antibiotics showed good survival.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.