SPECTRUM OF HEMODIALYSIS CATHETER RELATED BLOOD STREAM INFECTIONS: INSIGHTS FROM A PROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY CARE CENTER IN SOUTH INDIA

Introduction:

Catheter related blood stream infection (CRBSI) is a pressing concern in patients, who rely on central venous catheters (CVC) for hemodialysis. Despite advances in dialysis techniques and infection prevention protocols, CRBSIs remain a significant concern, particularly in developing countries like India, where data on infection patterns and outcomes are limited. It can lead to several complications including higher rates of morbidity and mortality, prolonged hospital stays, and increase healthcare cost. Understanding the local microbial landscape, resistance profiles, and risk factors associated with CRBSIs is essential for tailoring effective prevention and treatment strategies.

AIMS

To assess the incidence, microbial spectrum, risk factors, clinical outcomes, and antibiotic resistance patterns of CRBSIs among patients receiving haemodialysis at INU Bangalore.

Methods:

The single-center prospective observational study, conducted from April 2023 to August 2024 include patients undergoing maintenance hemodialysis or those with acute kidney injury (as per NKF-KDOQI guidelines) with definitive CRBSI as per IDSA guidelines. Patients with other concurrent infections, possible & probable  CRBSI were excluded. Blood cultures were obtained from both the CVC port and a peripheral vein prior to the initiation of antibiotic therapy and analyzed to determine the antibiogram. All patients were empirically started on intravenous antibiotics with coverage for both gram-negative and gram-positive pathogens.

Results:

During the 1.5-year study period, among the 229 events of catheter-related bloodstream infection (CRBSI), 163 events met the criteria of definitive CRBSI. The cohort was predominantly composed of males (64.4%) with a median age of 46 years and 20.85% were ≥ 60 years. CRBSI rate was 13.7 per 1000 catheter days with median duration of 22 days. Significant proportion of patients had right internal jugular venous temporary catheters and were fistula-naive. Identified risk factors included diabetes mellitus, immunosuppressive medications use, the type and the duration of catheter. Gram-negative organisms were the most frequently isolated pathogens, accounting for 70.56% (115/163) of cases, followed by gram-positive and fungal pathogens. Enterobacter cloacae was the most common gram-negative organism, found in 30.43% of cases. Among gram-positive organisms, Staphylococcus aureus was the most prevalent, comprising 58.34% of the gram-positive group, with both methicillin-sensitive (33.34%) and methicillin-resistant strains (25%) identified. Multidrug-resistant (MDR) organisms identified included predominantly Klebsiella pneumoniae (66.67%), followed by Pseudomonas aeruginosa and Acinetobacter baumannii. These MDR pathogens were found to be sensitive to colistin. Catheter removal was performed in most cases. The overall mortality rate was 1%, with mortality primarily attributed to multidrug-resistant (MDR) organisms and delay in hospitalisation.

Conclusions:

Higher CRBSI rate may be due to complexity of cases we handle, often requiring prolonged ICU stays. Early identification of infections, prompt catheter removal, and the initiation of appropriate antibiotic therapy are critical in improving clinical outcomes. Addressing the identified risk factors and resistance patterns is essential to reduce the incidence of CRBSI and enhance the quality of care for patients on hemodialysis

I have no potential conflict of interest to disclose.

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