Role of Endoluminal Catheter Colonization Surveillance Cultures to Reduce Catheter-Related Blood Stream Infections in Hemodialysis Patients

Abstract

Background: Central Venous Catheter (CVC) use as vascular access to the systemic circulation is highly vital for Hemodialysis (HD) patients. Catheter-related bloodstream infection (CRBSI) is the main complication of CVC use. Aim of the work: To assess the use of surveillance cultures (SCs) to prevent CRBSIs in asymptomatic HD patients. Patients and Methods: A prospective cohort study was conducted on eighteen HD patients with CVC, admitted to Dialysis Units of Benha University Hospitals and Meet Ghamr Nephrology and Urology Hospital during the period from October 2016 to March 2017. Endoluminal colonization of the catheter was assessed every 15 days by inoculating ~5 - 10 mL of endoluminal blood into aerobic blood culture bottles. Individual patients were triaged based on SC results: group 1 (negative); group 2 (coagulase-negative Staphylococcus [CoNS] with time-to-positivity (TTP) >14 hours); group 3 (CoNS with TTP ≤14 hours); and group 4 (any microorganism other than CoNS with any TTP or CoNS with Differential Time to Positivity (DTP) more than 120 minutes). Results: A total of 60 SCs were collected with a mean number per patient of 3.3. Of which 24 SCs (40%) were negative (group 1), and 36 SCs (60%) were positive (0 in group 2, 6 in group 3, and 30 in group 4). Under this protocol, the incidence density of CRBSI was 10.8 episodes per 1000 catheter days. Conclusion: SCs based on easily accessible samples proved useful in triaging HD patients at a high risk of infection.