Catheter-Related Blood Stream Infections and Associated Factors Among Hemodialysis Patients in a Tertiary Care Hospital

Abstract

Non-tunneled central venous catheter remains the preferred vascular access at hemodialysis initiation in developing countries despite a high burden of infection complications. The goal of this study was to determine the burden, risk factors, and microbiological spectrum of catheter-related bloodstream infections at a tertiary care center in Ethiopia. Methods: A retrospective cross-sectional study design was applied among patients who underwent central venous catheter insertion for hemodialysis between January 2016 and June 2022 with no native arteriovenous fistula and stayed more than 48 hours. Data were collected from the patient's registration book, patient charts, and microbiology registry and analyzed using SPSS 21. Binary logistic regression was applied to assess the relationship between the independent and outcome variables. P-values less than 0.05 with AOR and 95% CI were used as statistically significant variables. Results: In this study, 353 patients were included. The mean age was 39±17.9 years and the average duration of catheter stay was 58 ±95 days. A hundred thirty-five (38.2%) CRBSIs were documented with an incidence rate of 7.74 episodes per 1000 catheter days. The causative microorganism was predominantly gram-negatives (57.6%). Duration of a catheter (AOR: 0.3; P < 0.001), previous CVC infection (AOR: 11.9; P < 0.001), high white blood cell count (AOR: 0.31; P<0.001), urban residence (AOR: 1.92; P<0.05), and low hemoglobin levels (AOR: 2.78; P < 0.05) were independently associated with catheter-related bloodstream infections. Conclusion:In conclusion, the incidence of catheter-related bloodstream infection among patients on hemodialysis was high with gram-negative predominance. Early fistula must be planned to reduce the duration of temporary vascular access.

Bacteremia associated with non-tunneled central venous catheters in children undergoing chronic hemodialysis

“…1,3 In our site, the incidence rate of bacteremia was 3.15, lower than what has been reported in other studies (3.25-10.8 events per 1000 catheterdays). 8,11,12 In a retrospective study conducted by Sahli et al (in a mostly adult population), the incidence of bacteremia was high (10.8) and attributed to a lower adherence to hygiene standards during CVC insertion or maintenance. 8 On their side, Agrawal et al explained that the highest incidence (7.4) is due to both a poor adherence to care protocols by staff and the use of less strict criteria for the definition of CVC-related bacteremia proposed by the United States Centers for Disease Control and Prevention.…”

“…1,2 According to the different series, the incidence of bacteriemia a s s o c i a t e d w i t h n o n -t u n n e l e d C V C s i s 3.25-10.8 events per 1000 catheter-days, while that of tunneled CVCs is 0.55-5.5. [8][9][10][11][12][13][14] The most common microorganisms are Staphylococcus aureus or epidermidis. [8][9][10][11][12][13][14] Among adults, the risk factors for infection include a prolonged CVC dwell time, decrease in hemoglobin and albumin serum levels, prior catheter-related bacteremia, diabetes, iron overload, nasal colonization with Staphylococcus aureus, malnutrition, and advanced age.…”

“…[8][9][10][11][12][13][14] The most common microorganisms are Staphylococcus aureus or epidermidis. [8][9][10][11][12][13][14] Among adults, the risk factors for infection include a prolonged CVC dwell time, decrease in hemoglobin and albumin serum levels, prior catheter-related bacteremia, diabetes, iron overload, nasal colonization with Staphylococcus aureus, malnutrition, and advanced age. 8,11,13,15,16 Until 2019, in our department, hemodialysis was the initial dialysis modality in 82% of children with ESRD and was the continued therapy in 45%.…”

“…[8][9][10][11][12][13][14] Among adults, the risk factors for infection include a prolonged CVC dwell time, decrease in hemoglobin and albumin serum levels, prior catheter-related bacteremia, diabetes, iron overload, nasal colonization with Staphylococcus aureus, malnutrition, and advanced age. 8,11,13,15,16 Until 2019, in our department, hemodialysis was the initial dialysis modality in 82% of children with ESRD and was the continued therapy in 45%. 17 A temporary CVC was the initial access in 80% of patients because tunneled catheter insertion was not a routine practice.…”

Chronic kidney disease in Sri Lanka: Health systems challenges of patients on hemodialysis

“…Due to a high volume of cases and a dearth of surgical theatres, there are significant delays in the creation of AVFs. Studies indicate that the majority of patients begin dialysis treatment with temporary vascular catheters, which is regarded as a suboptimal method due to the associated inconvenience and the substantial risk of central-line-associated bloodstream infections [10,11].…”