Clinical characteristics and risk factors of dialysis catheter-related infection in CRRT patients

Abstract

Objective To explore the clinical characteristics and risk factors of catheter-related infection in continuous renal replacement therapy (CRRT) patients. Methods The demographic and clinical data of CRRT patients who inserted with double-lumen non-cuffed dialysis catheter at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2016 to December 31, 2016 were collected. According to the presence or absence of catheter-related infections, they were divided into infected group and uninfected group. Statistics and analysis of the incidence and pathogenic characteristics of catheter-related infections; Comparison of clinical features of infected and uninfected groups; A multivariate Cox proportional hazard model was used to analyze risk factors for catheter-related infections. Results A total of 364 patients with CRRT (437 cases of central venous catheterization) were enrolled in the study. Catheter-related bloodstream infection (CRBSI) and catheter-related colonization (CRCOL) rates were 3.565 and 2.228 events per 1000 catheter-days. These catheters were associated with higher proportion of inserted in ICU (P=0.007), immunosuppression (P=0.002), receive catecholamine inotropes therapy (P=0.001) and shock (P=0.030). The infection catheters also had shorter indwelling time (P=0.032) and lower level of blood hemoglobin (P=0.017), serum creatinine (P=0.004), blood brain natriuretic peptide (P=0.005) pericatheter use. The most common pathogens were Gram-negative bacteria, especially Acinetobacter baumannii, which caused 37.5% CRBSI and 20.0% CRCOL. Multivariate Cox regression model showed female (P=0.029, HR=2.151), diabetes (P=0.016, HR=2.807), receive catecholamine inotropes therapy (P=0.012, HR=2.655), immunosuppression (P=0.037, HR=2.203) were independent risk factors associated with catheter-related infection. Conclusions The incidence of CRBSI and CRCOL is 3.565 and 2.228 events per 1000 catheter-days CRRT patients in our hospital. The most common pathogen of catherter-related infection is Gram-negative bacteria. Female, diabetes, received catecholamine inotropic drugs, and immunosuppression were independent risk factors associated with catheter-related infection. Key words: Renal replacement therapy; Central venous catheter; Catheter-related infection; Risk factors; Pathogen