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The prolonged use of short-lived central venous catheter (CVC) is a reality observed in hemodialysis services in the Legal Amazon. The risk of complications is not confined to infections, but is associated with the use of protocols not based on the microbiological profile of our region and assistance to a mostly vulnerable population. This makes it difficult to choose an appropriate empirical antibiotic therapy that fits this reality. Thus, the study aims to identify the incidence of catheter-related infection, analyze the microbiological profile and the efficiency of the treatment that is being proposed.
Observational and retrospective study, carried out in a Dialysis Centre in a legal Amazon region, in the period from January 2021 to September 2023. The data were obtained from hemocultures collected through the short-stay CVCs exclusive for carrying out hemodialysis, from patients with Chronic Kidney Disease (CKD). Indication for collection was based on the clinical picture suggesting infection, such as fever, colds and/or flogistic signs in the catheter bone. From the time of collection until the arrival of the results, these patients were subjected to the use of the therapeutic regimen Vancomycin combined with Gentamicin. Patients who have had an infectious process already under previous use of antibiotic therapy were excluded.
322 hemocultures were collected, of which 99 confirmed infection, representing a rate of 30.7%. The microbial profile showed gram positive (58%), gram negative (41%) and fungi (1%). Infections were caused mainly by Staphylococcus aureus (32.3%), followed by Coagulase-negative Staphylococci (15.2%), Enterobacter spp (11.1%), Klebsiella pneumoniae (10.1%) and Enterococcus faecalis (8.1%). The results of the hemocultures were obtained with an average of 7 days. Comparing the main gram positive S. aureus vs. Coagulase-negative Staphylococci bacterial resistance was observed to quinolones (93.8% vs. 100%), oxacillin (21.9% vs. 86.7%), clindamycin (12,5% vs. 73.3%) and no resistance for vancomycin was detected. The most prevalent gram-negative (Enterobacter spp and Klebsiella pneumoniae) showed resistance mainly to cephalosporins and penicillins, while low resistance to aminoglycosides such as gentamicin (18%).
The absence of a Hospital Infection Control Commission and institutional standards that define an optimal standard of hemoculture collection, brings limitations for the study validate the real % of infections, and may be overestimated by collection contaminations. Nevertheless, the rate of catheter-related infection has been controlled and caused mainly by S. aureus. Bacterial resistance was low for the empirical antibiotic therapy carried out, showing its effectiveness, however there may be a possibility of discharging, avoiding the inviability of the use of these antibiotics in the future. The results obtained by this study prompted the beginning of the construction of a protocol of its own and relevant with the microbiological, cultural and socio-economic profile of the region in order to impact in the control and management of infections.