Haemodialysis catheter-related blood stream infection in ESRD patients: incidence, outcome and antibiogram of the isolated organisms

Abstract

Background: Catheters are used in roughly between 60- 80% of patients at the time of initiation and 25-30% of all prevalent patients as a bridge to permanent vascular access. Relative risk of mortality due to the dreaded complication of bacteraemia is multiple folds higher with the use of haemodialysis (HD) catheters compared to AV fistulas. In the present study we investigate the incidence, causative organisms and the final outcome of catheter related blood stream infections (CRBSI) in haemodialysis patients. Methods: It was a retrospective cross-sectional study carried in a tertiary care hospital in north India which included adult (>18 years) ESRD patients with the diagnosis of HD CRBSIs in a duration of 2 years . Results: Forty two cases of infection were reported in 39 subjects. In the temporary uncuffed catheter (TUC) group expired patients were older, had lower haemoglobin levels and longer hospital stay although none was significant. In the permanent cuffed catheter group expired patients had longer hospital stay, lower haemoglobin levels. Catheter removal was significantly more in TUCs and salvageability was significantly more in PUCs (p = 0.0035). The rise in Acinetobacter and Citrobacter positive cases and the growing resistance against third generation cephalosporin, carbapenems was a notable phenomenon amongst gram negative organisms. Conclusions: Hemodialysis patients with catheter as vascular access presenting with fever, the first differential diagnosis is CRBSI. They can be managed on an outpatient basis barring those with evidence of severe sepsis. Early removal of temporary uncuffed catheters can give good results in selected patients .