EMBOLIC INFECTIOUS COMPLICATIONS OF HEMODIALYSIS CATHETER - A CASE SERIES

Introduction:

Hemodialysis Catheter-Related Bloodstream Infections (CRBSIs) are more common and have a 2-3 fold risk of hospitalisation and death compared to A-V fistula. Hemodialysis catheter-related bloodstream infections are the most common complications, with a reported incidence of 1.1-5.5 per 1000 catheter days. However, metastatic infectious complications of CRBSIs, such as infective endocarditis, osteomyelitis, septic emboli, etc., are not common.

Methods:

Results:

Case 1

A 40-year-old man on maintenance hemodialysis for three months presented with fever, cough, and dyspnea for three days. On evaluation, the patient’s CT chest revealed consolidations with multiple cavitary lesions. Bronchoalveolar lavage (BAL) was done, which revealed Escherichia coli. Paired blood cultures and catheter tip culture showed the growth of Escherichia coli. He was diagnosed with CRBSI-related septic emboli, the HD catheter was changed, and appropriate antibiotics were given for four weeks. The patient improved and was discharged on MHD.

Case 2

A 40-year-old man with T2DM, HTN, and CKD on MHD through Right IJV temporary HD Catheter for three months presented with fever, generalized weakness, and shortness of breath for three days. He developed a sudden onset of weakness in the left lower limb, and an MRI revealed multiple lacunar infarcts bilaterally, which was possibly due to emboli. 2D ECHO revealed Large vegetation over the left atrial surface of the Posterior Mitral Leaflet (PML). Repeat cultures were negative. He was diagnosed with CRBSI-related culture-negative native valve infective endocarditis with septic emboli. He was started on appropriate antibiotics. However, he succumbed to death in 3 days with septic shock.

Case 3

A 35-year-old woman with CKD on MHD for two weeks presented with cough and dyspnea for 4 days. The patient had pain in the left hip, and an X-ray revealed osteomyelitis with a stress fracture. CT chest revealed multiple cavitatory lesions in the B/L lung field, suggesting septic pulmonary emboli. Paired blood cultures revealed Staphylococcus aureus. She was diagnosed with CRBSI-related septic emboli and osteomyelitis. She was started on appropriate antibiotics and planned for BAL, but she succumbed in 2 days to septic shock.

Case 4

A 31-year-old woman with CKD on Tunneled Central Venous Catheter (TCC) on MHD for ten months presented with fever and dyspnea for 30 days. TCC was changed because of CRBSI. However, she had recurrent fever despite TCC exchange. During the evaluation, 2D ECHO showed vegetation on the posterior mitral leaflet. Her paired blood cultures showed Pseudomonas aeruginosa. She was treated with appropriate antibiotics, after which she had symptomatic improvement, and was planned for a definitive surgery at a later date.

Conclusions:

CRBSIs with embolic complications are rare. However, in a resource-limited setting, such complications are becoming increasingly common due to the longer duration of catheter use.

I have no potential conflict of interest to disclose.

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