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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Catheter-related bloodstream infections (CRBSIs) remain a leading cause of morbidity in hemodialysis patients. While Gram-positive bacteria are often implicated, multidrug-resistant Gram-negative organisms like Pseudomonas aeruginosa and Stenotrophomonas maltophilia are emerging as significant pathogens, form resilient biofilms, and presents a significant therapeutic challenge. Herein, we present a case of recurrent CRBSIs in a chronic hemodialysis patient, where the catheter—the essential conduit for life-sustaining treatment—became the source of sequential and overlapping bloodstream infections with both P. aeruginosa and S. maltophilia.
Case Illustration
A 60-year-old male with end-stage renal disease (ESRD) and diabetes presented with fatigue and a trend of declining hemoglobin (Hb) without active bleeding. One month prior, the patient developed a fever during hemodialysis (HD) and was diagnosed with a catheter-related bloodstream infection (CRBSI). A blood culture from the catheter identified Pseudomonas aeruginosa. Consequently, the catheter was replaced, and the patient was administered a 10-day course of intravenous antibiotics consisting of Meropenem 1g twice daily and Levofloxacin 750mg every 48 hours.
Following this treatment, the patient remained afebrile. However, he continued to experience fatique with each hemodialysis session. The patient underwent hemodialysis three times per week and receives a total of 12,000 units of Erythropoietin weekly. Despite this, his Hb level continued to decline from 9.8 g/dL to 7.5 g/dL over a two-month period.
The patient has grade 3 obesity with a dry body weight of 120 kg. His iron status showed a transferrin saturation of 50% and a markedly elevated serum ferritin level of 1185 ng/mL. The evaluation for the cause of hyperferritinemia revealed an elevated Procalcitonin (PCT) level, a marker of infection. A subsequent blood culture isolated Stenotrophomonas maltophilia. The patient was then treated with a 10-day course of intravenous Levofloxacin 750mg every 48 hours.
Discussion
Hyperferritinemia in this patient can be attributed to obesity, diabetes mellitus and underlying infection/inflammatory state. The elevated PCT level indicated a bacterial infection, prompting a blood culture which returned positive for Stenotrophomonas maltophilia, a gram-negative bacillus. The WHO classifies S. maltophilia as an emerging multidrug-resistant pathogen of concern due to its increasing prevalence and status as a multi-drug resistant organism, including cephalosporins and carbapenems. This bacterium is often an opportunistic infectious agent in immunocompromised individuals, including HD patients and those using Central Venous Catheters (CVCs), and it thrives in moist environments. It is noteworthy that S. maltophilia frequently co-occurs and forms multispecies biofilms with Pseudomonas aeruginosa, as was observed in this patient. Given that fluoroquinolones demonstrate susceptibility rates as high as 80-90% for some isolates, they represent a strong empirical antibiotic choice in such cases.
Hemodialysis catheter has dual role not only as a lifeline but also as a potential source of lethal infection. The recurrent CRBSIs with P. aeruginosa and S. maltophilia highlight the perils of biofilm formation and the emergence of multidrug-resistant pathogens in vulnerable patients.
