Main determinants of tunneled cuffed catheters infection in hemodialysis patients

Abstract

Introduction: Despite all efforts to prevent tunneled-cuffed catheter (TCC) infection, the incidence of this infection has remained considerably high. Objectives: The present study aimed to assess risk determinants affecting TCC infection in hemodialysis patients. Patients and Methods: This case-control study was performed on 165 consecutive patients as known cases of end-stage renal disease on maintenance hemodialysis through double-lumenTCC. The patients were assigned into two groups as the case group with the clinical evidences of TCC infection and the control group with noninfectious condition. Results: In the group with TCC infection, the most common microorganisms cultured in the medium included Staphylococcus aurous and Staphylococcus epidermidis with the overall prevalence of 17.6% and 15.3% in blue lumen and 14.1% and 14.1% in red lumen, respectively. Overall, 75.3% of the lumens were positive for infection, while 52.9% of blood cultures were positive. Multivariable logistic regression modeling showed that female gender, insertion catheter through jugular vein, higher C-reactive protein (CRP) level, lower serum iron level and higher serum ferritin level could predict TCC infection in dialysis patients. According to ROC curve analysis, measuring CRP level, serum iron and serum ferritin could effectively discriminate TCC infection from noninfectious condition. Particularly, serum CRP >16 mg/ dL, ferritin > 200 ng/mL and serum iron <40 mg/dL could predict TCC infection. Conclusion: Around 75% of samples extracted from catheter lumens are positive for TCC infection. The main determinants of TCC infection included female gender, insertion catheter by jugular vein, higher CRP level, lower serum iron level, and higher serum ferritin level.