Haemodialysis Central-Line Associated Bloodstream Infection : Incidence, Risk factor, and Antibiogram

Abstract

Background The incidence of central-line associated bloodstream infection (CLABSI) is one of the complications of using a temporary HD catheter is one of the causes of HD patient morbidity and mortality. Identifying CLABSI risk factors and causative micro-organisms are important for setting prevention policies. There were no data regarding CLABSI in hemodialysis in Indonesia Objective: This study identified the epidemiology and risk factor of HD CLABSIs and to aid in the choice of empiric antibiotics therapy given to patients with HD CLABSI Method: This study was an analytical observational study with a cross-sectional design conducted at the Inpatient Installation of Dr. Soetomo General Hospital in August 2018 - January 2019. The study population was patients with installed non-tunneled double lumen hemodialysis catheters more than two calendar days established. The inclusion criteria in this study were the patient 18-60 years old and any clinical presentation of fever, chills, and or hypotension. HD patients who presented with other sources of infection were excluded from the study. Data analysis was performed using SPSS v.23. Results: In this study, 42 subjects were included in the composition of male: female 24: 18, with an average age of 49.62 years. The incidence of CLABSI is 11,3 /1000 catheter days. The results of blood cultures by gram-negative bacteria were 51.86%, and gram-positive bacteria were 48.14%. The most bacterial causes of CLABSI were Staphylococcus aureus by 25.9%. The most gram-positive bacteria causing CLABSI Staphylococcus aureus was 53.84%. The most gram-negative bacteria that caused CLABSI was Enterobacter cloacae at 53.84%. Antibiotics that have the highest sensitivity to gram-positive bacteria are Fosfomycin, Teicoplanin, and Chloramphenicol. Antibiotics that have the highest sensitivity to gram-negative bacteria are Cefoperazone Sulbactam, Imipenem, and Meropenem. There was a statistically significant relationship between DM and CLABSI events (OR = 3.896; p 0.037). There was a statistically significant relationship between hypoalbuminemia and the incidence of CLABSI (OR = 4,524; p 0,023). Conclusion: This study found S. aureus was the most common cause of CLABSI. Our study was unusual as a high prevalence of gram-negative bacteremia was found in HD patients. Diabetes mellitus and hypoalbuminemia increase the risk of CLABSI in hemodialysis patients.