Introduction:
Catheter-related bloodstream infection (CRBSI) is a leading cause of nosocomial bacteraemia and is among the most frequent, serious, and expensive complications associated with cuffed tunneled catheter use1. This infection most often manifests as fever during haemodialysis (HD). Infective endocarditis is also one of the dreaded complications of indwelling HD catheter2. This study explores the implications of transoesophageal echocardiography (TEE) in End Stage Renal Disease patients (ESRD) on Maintenance HD presenting with fever who have a long term cuffed tunneled catheter in situ.
Methods:
This is an observational cross-sectional study done in span of three months at a tertiary care centre in western India, after institutional ethical clearance, fifty patients with ESRD undergoing maintenance HD through cuffed tunneled catheter presenting with fever were enrolled. Transthoracic echocardiography (TTE) was performed on all patients, and for those in whom vegetation or clot was suspected, transoesophageal echocardiography (TEE) was carried out to confirm and differentiate between vegetations and clots. Point prevalence of CRBSI, infective endocarditis and other causes of fever were determined.
Results:
Our findings revealed 17 (34%) out of 50 patients had CRBSI, out of which five (10%) patients had vegetation on catheter tip. TEE was done in 32 (64%) out of 50 patient in whom vegetation/clot was suspected. Of those 32, 5 (16%) had vegetations and 2 (6%) had clot. Infective endocarditis was diagnosed in six (19%) out of thirty two patients, of whom five (16%) had vegetations.
Conclusions:
One-third of ESRD on MHD patients with fever had CRBSI. Out of CRBSI diagnosed patients, one-third of them had infective endocarditis. This study underscores the need for TEE in the diagnostic algorithm for febrile patients with cuffed tunneled catheters, potentially leading to improved patient outcomes. Further research is warranted to establish standardized guidelines for the use of TEE in clinical scenario as above. This study adds to the existing literature on the management of cuffed tunneled catheter complications and provides valuable insights for clinicians.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.