Incidence and challenges in management of hemodialysis catheter-related infections

Abstract

Catheter-related infections (CRI) are a major cause of morbidity and mortality in chronic hemodialysis (HD) patients. In this paper, we share our experience with CRI in HD patients. We recorded 49 cases of CRI among 167 patients during a period of 40 months (January 2018–April 2021). The incidence of CRI was 3.7 per 1000 catheter-days. The revealing symptoms were dominated by fever or chills (90%). Inflammatory signs were observed in 74% of cases with respectively concurrent exit-site (51%) and tunnel infection (6%). The biological inflammatory syndrome was found in 74% of patients (average CRP level = 198.9 mg/l). Blood cultures were performed in all cases and were positive in 65% of cases. Thirteen patients have been diagnosed with Infection complications, which were respectively infective endocarditis in 7 cases, septic arthritis in 3 cases, infective myositis in one case, cerebral thrombophlebitis in 1 case and mediastinitis in 1 case. The death occurred in eleven patients, it was due to septic shock in 9 cases, pulmonary embolism in one case and neurologic alterations related to cerebral thrombophlebitis. The mean seniority in HD was 16.5 months in the group with CRI and 3.7 months in the group without CRI (p < 0.04). We did not notice significant difference in mortality between tunnelled and non-tunnelled catheters. CRI does not seem to be more severe in patients with diabetes. Duration of use of the HD catheter (p < 0.007) and ferritin level (p < 0.0001) were independent factors that predispose to CRI in our population.

Clinical Clue and Predictive Blood Count of Hemodialysis Cathether-Related Infection: Case Series

“…Study by Haiji et al, reported the mean duration of dialysis was 16.5 months in the group with catheterrelated infection and 3.7 months in the group without catheter-related infection (p < 0.04). (23) Study by Shoaib et al, reported majority of CRBSI patients underwent hemodialysis over 6 months (p < 0.05). (14) Shahar et al, reported that the majority of CRBSI patients underwent hemodialysis over 3 month (87%).…”

Clinical Outcome of Patients with Escherichia coli Isolated from Catheter Lumens and/or Peripheral Blood Cultures: A Retrospective Analysis

“…The incidence of C-RBSI caused by Gram-negative bacilli [ 2 , 7 ], while still low, has increased in recent years [ 5 , 6 , 23 ], mainly among oncologic patients and those undergoing hemodialysis [ 1 , 2 , 3 , 4 ].…”

“…Staphylococci are the main cause of catheter-related bloodstream infection (C-RBSI). However, the Gram-negative bacillus Escherichia coli , which can form biofilms on the catheter surface, remains an important agent in specific populations, including patients with oncologic–hematological conditions and those undergoing hemodialysis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ].…”

Early Detection of Inflammation and Malnutrition and Prediction of Acute Events in Hemodialysis Patients through PINI (Prognostic Inflammatory and Nutritional Index)

“…Hospitalization duration is prolonged, necessitating increased effort from medical staff and, not least, incurring higher costs [ 27 ]. CVC usage in hemodialysis patients is associated with a 7-fold higher risk of infection compared to those using native FAV and a much consistent risk of the malnutrition–inflammation syndrome compared to those with FAV [ 31 , 32 , 33 ].…”