Microbial Etiology of Hemodialysis Related Central Venous Catheter Exit Site Infections Following Use of Triple Antibiotic Ointment to Insertion Site

Abstract

BACKGROUND/OBJECTIVES: Catheter related infections are a serious and common complication in Hemodialysis (HD) patients who are dependent on central venous catheters (CVC) for their access. Applying Triple Antibiotic Ointment a broad spectrum topical antibacterial ointment containing Polymyxin B Sulfate, Bacitracin Zinc and Gramicidin to the CVC insertion site has been found to reduce the incidence of catheter related infections. OBJECTIVE: To assess the frequency of exit site infections and the proportion due to Candida sp after instituting a practice of applying Triple Antibiotic Ointment to the insertion site of CVC catheters. METHODS: The patient population included in this project was a convenience subset of a Regional Dialysis population. All HD patients in 4 of 17 HD units within our Renal Program using a permanent tunneled and cuffed CVC for their HD access were included. Patients were surveyed from January 1 to March 31 2005. During this period a thin film of Triple Antibiotic Ointment was applied by dialysis nurses 3 times /week before each HD episode. Patient dialysis charts and culture reports from swabs of CVC sites were regularly reviewed. The Canadian definition for exit site infections was used to determine the presence or absence of infection. RESULTS: There were 306 HD patients and 147 patients used a permanent tunneled and cuffed CVC for their HD access. There were fifteen exit site infections in 15 patients during the 3 month survey, 2.7 per 1000 patient runs, 1.16 per 1000 catheter days. Of the 15 infections five (33%) were yeast infections. Other identified pathogens were Coagulase-negative Staphylococcus, Staphylococcus aureus, Enterococcus sp, Pseudomonas aeruginosa and Diphtheriods . CONCLUSIONS: Following implementation of topical antibacterial prophylaxis of CVC exit sites, there has been an apparent increase in Candida sp as a cause of CVC site infections. A longer term study is warranted to confirm these results.