POS-560 HEMODIALYSIS CATHETER ASSOCIATED BLOODSTREAM INFECTIONS (CABSI) AT A TERTIARY CARE HOSPITAL IN NORTH INDIA: INCIDENCE,OUTCOME AND ANTIBIOGRAM OF THE ISOLATED ORGANISMS

Abstract

Infections are common complications among patients on hemodialysis. In North India, emergency dialysis initiation with hemodialysis catheter is the norm. Thereafter patients defer AV-Fistula construction for financial and logistic reasons, with <50% having a functional AV-Fistula even 4 months after dialysis initiation. Hemodialysis patients with a catheter have a 2- to 3-fold increased risk of hospitalization for infection and death compared with patients with an arteriovenous fistula or graft. Prompt diagnosis for early treatment is essential to avoid complications including catheter removal and endocarditis. We studied the incidence, microbiological spectrum and outcomes of CABSI at a tertiary care hospital in North India. In this retrospective-prospective observational cohort study, all adult (>18 years) patients who underwent tunnelled or non-tunnelled hemodialysis catheter insertions were screened during a period of 2 ½ years (January 2018 to June 2020). Patients who were suspected to have CABSI were confirmed by CDC guidelines for diagnosis of central line-associated bloodstream infections. 1010 patients underwent catheter insertion during this period and 160 patients fulfilled the diagnostic criteria. CABSI incidence was 27.33 episodes per 1000 catheter days and median infection-free survival of the catheter was 3.28 weeks. The cumulative hazard for CABSI was 1.3, 10.6, 41.2 and 65% at 1, 2, 3 and 4 weeks respectively. Median catheter days for tunneled catheter were 117 days and for non-tunneled catheter were 23 days. The incidence of CABSI among femoral and triple lumen catheters was higher as compared to jugular and double lumen catheters respectively (p value <0.0001). The majority of patients (52.5%) were between 51-70 years of age and were mostly male. Hypertension was present in majority (96.25%) of patients, followed by Diabetes mellitus. The most common symptom was fever, followed by chills and hypotension. 100 patients were managed in ICU, 45 patients were managed in the ward and 15 patients were managed on OPD basis. Gram negative were the dominant organisms, followed by common commensals, gram positive and fungi (Figure 1). E. coli was the most commonly grown gram negative organism. High total leucocyte count and high serum procalcitonin distinguished Gram-positive and Gram-negative infections from those by common commensals. 58 antibiotic resistant strains (36.25%) were cultured. The rise in Acinetobacter positive cases and the growing resistance against third generation cephalosporins, carbapenems was a notable phenomenon amongst gram negative organism. In 139 cases of CABSI, catheter was removed once CABSI was diagnosed. The need for hospitalization and complications was significantly higher in gram positive, gram negative, fungal as compared to common commensals (p value=0.006). Mortality was significantly higher in gram positive, fungal as compared to gram negative and common commensals (p value=0.02). 12 CABSI were complicated by endocarditis. Mortality rate was 17.5%, sepsis being the most common cause of death. In this study, CABSI occur early and are predominantly Gram negative. We hypothesize that poor hygiene practices may play a role in this phenomenon. Growing prevalence of gram-negative bacteria has been related to the immunocompromised state of patients, contaminated infusate and overexposure of antibiotics.