Back
The frequency of end-stage kidney disease (ESKD) and subsequent demand for life-saving kidney replacement therapy (KRT) is rising in Africa. However, only 10% of adults living in sub-Saharan Africa have access to KRT. Many patients die within 6 months of the initiation of haemodialysis (HD), which may be related to, among others, vascular-access-related complications. This study determined the incidence of catheter-related bloodstream infections (CRBSIs), microbiological profile of causative organisms, and associated predictors in patients on chronic HD.
A prospective single-center cohort study of 121 adult patients with end-stage kidney disease was conducted from October 2019 to March 2020. Antibiotic susceptibility was determined by the Kirby–Bauer disk diffusion method. Cox proportional hazards model was used to determine predictors of CRBSI including age (>60 years), dialysis vintage, previous blood stream infection and anaemia.
The mean age was 50 ±14.9 years and the median duration of follow-up was 69 (interquartile range 23–124) days. At least one CRBSI was recorded for 41% of patients, at a rate of 5.2 infections per 1000 patient-days. Causative organisms were predominantly Gram-negative bacteria (60.3%), and 36.5% of all isolates were multi-drug resistant. Anaemia [hazard ratio (HR) 5.44, P = 0.019, 95% confidence interval (CI) 1.32–22.48] and previous bloodstream infection [HR 2.47, P = 0.028, 95% CI 1.10–5.54] were predictors of CRBSI.
The high incidence of CRBSI in patients on chronic HD with predominance of Gram-negative bacteria means that funding should be allocated to the promotion of fistula-first initiatives and catheter care bundles should include Gram-negative coverage.