Association between the Biofilm of Double-Lumen Catheter and Blood Culture in Hemodialysis Patients with Suspected Central Line-Associated Bloodstream Infection

Abstract

Abstract Background One complication of double lumen catheter (DLC) for hemodialysis (HD) is central line associated bloodstream infection (CLABSI). Blood culture examination is still the gold standard for diagnosis. CLABSI is also often associated with biofilm formation. Biofilms can cause recurrent bacteremia and antibiotic resistance thereby increasing mortality and morbidity. Until now in Dr. Soetomo General Hospital, there have been no objective data or research on the relationship between biofilms and blood cultures in patients with systemic infections associated with catheters. Objective: This study aims to analyze the relationship between the biofilms of double lumen catheter and blood cultures in hemodialysis patients with suspected CLABSI. Method: This was an analytic observational study with cross sectional design to determine the relationship of biofilms and blood culture in HD patients with suspected CLABSI at Dr. Soetomo General Hospital in August 2019 - November 2019. Inclusion criteria: patients aged >18 years with routine HD and suspected CLABSI, also were willing to participate in the study with informed consent. Exclusion criteria: other sources of infection. Biofilm examination on DLC using the test tube method was measured with a nephelometer. Biofilm results is positive if ≤ 0.36 MF and negative if > 0.36 MF. Blood was cultured with a 3D BacT/ALERT tool in the Clinical Microbiology Installation Laboratory of Dr. Soetomo General Hospital. Results: Of the 33 subjects, 45.5% were men and 54.5% were women, with an average age of 49.06 ± 1.5 years. The most common cause of CKD is hypertension (54.5%). The median length of HD was 3 months, ranging from 1-8 months. DLC were mostly inserted at subclavia dextra (87.9%) and installed with a mean duration of 77.94 ± 5.22 days. The majority (66.7%) had normal nutritional status. The mean albumin level was 3.28 ± 0.07 g/dL. There was biofilm growth in 16 subjects (48.5%). The evaluation of blood culture revealed 15 positive results (45.5%). The analysis between biofilm density and CLABSI found significant differences between the two groups (p=0.024). From chi-square test, the association of biofilms with blood culture in HD patients with suspected CLABSI obtained a p value of 0.001. Conclusion: Patients with suspected CLABSI and positive bacteria growth in blood cultures had biofilm in DLC. In addition, the density of biofilms in DLC is higher CLABSI cases. Keywords: chronic kidney disease, CKD, Double lumen catheter, Biofilm, Blood culture, Infection, CLABSI