Background: The central venous catheters (CVC) has recently become a worldwide commonest technique for vascular access, however; prone to infection and associated with other complications more than other vascular access techniques, such as fistula or graft. Objective: To investigate the incidence, the types of micro-organism, the most sensitive and suitable antibiotics, the outcomes associated with CVC infection in chronic hemodialysis patients treated through tunneled CVC.in a single-center population. Methods: The records of hemodialysis patients from January 2012 to December 2016 were reviewed. Patients above 14 years of age, on hemodialysis via a permanent tunneled catheter at any time of the mentioned period, were included. The rate of CRBSI (Catheter-Related Blood Stream Infections) was calculated as density of incidence and reported per 1000 catheter days. Patient mortality was recorded. Results: In 5 years, a total of 73 episodes of CRBSI in 49 hemodialysis patients were recorded. 59.2% were male with a mean age of 53.57 years. 40.8% had end-stage kidney disease secondary to diabetic nephropathy. In all, 67.3% episodes grew Gram-positive isolates, among those staphylococci epidermidis (26.4%, n=19) and staphylococci aureus (25%, n=18) were the most common organism, whereas Klebsiella pneumonia (8.3%, n=6), Enterobacter cloacae (8.3%, n=6), pseudomonas aeruginosa (5.5%, n=4) and E.coli (5.5%, n=4) were the most common Gram-negative isolates. A total of 6 isolates were multidrug-resistant, which includes Klebsiella pneumonia, Citrobacter, and E. coli. Only 1 out of 18 staphylococci aureus cases were methicillin-resistant and 21% (n=6) of Gram-negative isolates were Extended-spectrum beta-lactamase (ESBL) producing organisms. The average hospital stay was 9 days (2-30 days). The hemodialysis catheter was removed for 19 (38.77%) patients and 4 (8.1%) patients expired due to septic shock despite catheter removal and being on appropriate antibiotics. Conclusion: The mainstay to reduce CRBSI would be ideal to avoid catheters or decrease the duration of catheters. This can be achieved through more aggressive counseling and fast-track protocols for AV Fistulae creation at the pre-dialysis stage.

Risk factors that had effect of outcomes includes increased age, diabetes, uncontrolled hypertension and anaemia, hypoalbunaemia and infection mainly catheter related infection who stat dialysis with temporary catheter. Cost of dialysis includes dialysis cost, transport cost, medicine cost and cost of helping persons. Total monthly average cost of dialysis in government hospital about 12000-15000 taka.(15-20USD) Conclusions: We concluded that 23% patients leave dialysis due to financial or helping personal or social support. They leave dialysis within 3-4 months. 35% patients died due to multiple risk factors within 8-9 months. Further study required to identify risk factors for early mortality and increase dialysis support and quality of dialysis. For early discontinuation there might be increase social security and social support and government level.