Catheter-related blood stream infections in hemodialysis patients

Abstract

Introduction: Proper care of vascular access in hemodialysis patients is important. Catheter-related bloodstream infection (CRBSI), is a life-threatening complication of hemodialysis. Objectives: Sufficient data about microorganisms and their susceptibility to antibiotics in hemodialysis patients is necessary for handling of CRBSI; therefore, this study performed for better management of patients. Patients and Methods: All hemodialysis patients from March 2015 to March 2018 who had cultures of catheter and blood samples were studied. Clinical records of 122 patients were reviewed for variables such as catheter and blood culture microorganism types, antibiotic resistance, age, gender, site, comorbidities, and various clinical signs. Results: Eighty-four cases of catheter cultures were positive for bacteria. Staphylococcus epidermidis was the most common organism (36%) since Staphylococcus aureus was the second one (28%). In some cases, multidrug resistant organisms such as Enterobacter baumannii or methicillin-resistant Staphylococcus aureus (MRSA) organisms were grown. Twenty-one percent of S. aureus organisms were MRSA. No significant association between important diagnostic data (fever, chills or WBC count) and bacteremia were shown. Gender of patients had a significant statistical association with CRBSI. Conclusion: Given the necessity of proper management, physicians must empirically initiate antibiotic therapy as soon as possible, until receiving definite culture results, in hemodialysis patients suspected of bacteremia. In our study, both gram-positive and gram-negative organisms were common. Hence, when initial empirical treatment is indicated, the coverage of both gram positive and gram negative organisms must be considered. Vancomycin or other antibiotics that are effective on MRSA must be included in empirical treatment.