MON-127 CLINICO-MICROBIOLOGICAL PROFILE AND OUTCOMES OF CENTRAL CATHETER RELATED BLOOD STREAM INFECTIONS IN HEMODIALYSIS: A SINGLE CENTRE STUDY

Abstract

Central catheter related blood stream infections (CCRBSI) are serious infections in hemodialysis (HD) and are associated with significant morbidity and mortality. With frequent use of HD catheters and indiscriminate use of antibiotics, there is a rise in CCRBSI incidence with emergence of drug resistance. There is scarce data on incidence, clinical profile and course of CCRBSI in HD catheters. To study the clinical profile, microbiology, outcomes and factors associated with CCRBSI in HD catheters in a tertiary care centre. A prospective study was conducted from 01 Jan, 2017 to 30 Jun, 2018 in our hospital, in which all patients with HD catheters in jugular and subclavian veins were included. All catheters were inserted under USG guidance. Patients were grouped into tunneled catheters (TCC) or non-tunneled (NTCC). The details of patient demography, clinical, biochemical parameters and any immediate complications were recorded. The patients were followed for CCRBSI. Catheters were removed if any complication or when it is no longer required. In case of CCRBSI, catheter duration, microbiology and antibiotic sensitivity were recorded. Statistical analysis was performed using Strata 14. Study was approved by institutional review board. Of the total 461 HD catheters, 384 (83.3%) were NTCC and 77 (16.7) were TCC. The mean age of patients was 42.3 ± 15.0 years with 287 males (62.2%). 112 patients had diabetes (24.2%). 103 (22.3%) patients had previous history of CCRBSI. History of recent sepsis (other than catheter related) was present in 133 cases (28.85%). 49 (43.7%) of diabetic patients had CRBSI compared to 95 (27.2%) of non-diabetics. Complications were seen in 184 (39.91%) cases and 158 (34.2%) catheters were removed in view of various complications. CCRBSI was the commonest complication seen in 144 (31.2%) cases with an incidence of 6.12 per 1000 catheter days. It was 8.80 and 2.49 per 1000 catheter days in NTCC and TCC groups respectively. The median number of catheter days was 30 days (range, 1-120) for NTCC and 180 days (15-180) for TCC. The median number of catheter days for NTCC with complications was 42 days (range, 1-102) and was 22 days (range, 5-120) for NTCC removed electively. Thirty-four (23.6%) cases of CCRBSI were culture positive. The infection free survival at 30, 60, 90, 120 and 180 days for NTCC was 41.6, 7.1, 1.8, 0, 0% and for TCC 91.5, 86.4, 82.1, 75.4 and 39.2% respectively. The organisms causing CCRBSI were gram positive in 17 (Staphylococcus aureus in five, Staphylococcus epidermidis in three, other coagulase negative Staphylococcus in nine and gram negative in 12 (Klebsiella pneumoniae in five, E. coli in two and P. aeruginosa in five). On multivariate analysis, risk factors for CRBSI were presence of underlying systemic sepsis (OR=1.20, 95% CI 1.14 to 1.62, p 0.02), number of catheter days (OR=1.2, 95% CI 1.01 to 1.71, p 0.02) and diabetes (OR=1.22, 95% CI 0.92 to 1.81, p 0.005). CCRBSI were seen in 31.2% cases (6.12 per 1000 catheter days) and were significantly more common in non-tunneled catheter. Gram positive organisms were more common. Presence of underlying sepsis, diabetes and longer duration of catheter use predisposed to CCRBSI.