POS-566 CATHETER RELATED BLOODSTREAM INFECTION (CRBSI) IN A MIDDLE-EASTERN COHORT OF HEMODIALYSIS PATIENTS: AN ANALYSIS OF 5 YEARS OF FOLLOW UP DATA

Abstract

Bloodstream infections (BSI) are the second commonest cause of morbidity and mortality in end stage renal failure (ESRF) patients. Dialysis catheters are believed to be the most common contributors to BSI in this cohort. Therefore, patients who are receiving hemodialysis via long term central venous catheters (CVC) are at significantly high risk of CRBSI and its associated morbidity and mortality. Although there are several studies on CRBSI from different cohorts around the world, long-term follow up data are scarce particularly from middle eastern cohorts. We aim to fill this knowledge gap as well as to develop an antibiogram and antibiotic stewardship for this unique cohort of patients. This is a single center retrospective longitudinal study of a middle eastern cohort receiving three times a week regular hemodialysis via permanent CVC in a large out-patient setting. We analyzed all the data from December 2015 to November 2020. Data on incidents of CRBSI, etiology, antimicrobial susceptibility, CRBSI risk factors, and comorbidities were collected. For the sake of our study, we defined CRBSI with the isolation of the same microorganism from the CVC and peripheral blood culture without any other apparent source. The incidence of CRBSI was expressed as incidence per 1000 catheter days. A total of 39 incidents of CRBSI were identified during these 5 years study period. Of the reported cases, 94% grew a single organism while 6% grew polymicrobial. Of the multitude of organisms isolated, 39% were gram positives while the rest were gram negatives. Staphylococcus aureus and enterococcus were predominant gram positives while pseudomonas and klebsiella were the predominant gram negatives. No case of MRSA or fungi were isolated. The distribution of organisms is illustrated in the bar chart below. Interestingly only 70% of cases presented with the typical triad of fever, rigors, and exit site exudates, while around 20% presented with only hypotension. 10% of the cases were completely asymptomatic and were only incidental findings. The incidence of CRBSI per 1000 catheter days was calculated for every month and as illustrated by the graph below, the CRBSI rates seem quite variable throughout this study period. However, interestingly, since the beginning of the COVID19 pandemic outbreak, the CRBSI rates are conspicuously low. This might be explainable by enhanced focus on hand hygiene by both the staff and the patients themselves during this pandemic. CRBSI incidences were higher among patients with longer duration of catheter use, previous bacteremia, old age, diabetes mellitus, and recent hospitalization.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The incidence of CRBSI reported from our center seems to be comparable to other international centers around the world. The causative microorganisms and their antibiotic susceptibilities also seem to be in concordance with the rest of the world despite variations in geography, climate, and ethnicity. We conclude, that irrespective of the differences in the geographical location and study cohorts, strict adherence and attention to hand hygiene and infection control practices by both the staff and the patients are the keys to keeping CRBSI low.