Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study

El-Kady, Rania Abd El-Hamid; Waggas, Dania S.; Akl, Ahmed

doi:10.2147/idr.s333438

Cited by 8 publications

(11 citation statements)

References 34 publications

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“…Page 13/18 1 Calculated in relation to 95 isolates, 2 Calculated in relation to 65 isolates, 3 Calculated in relation to 66 isolates, 4 Calculated in relation to 93 isolates, 5 Calculated in relation to 89 isolates 6 Calculated in relation to 54 isolates, 7 Calculated in relation to 23 isolates, 8 Calculated in relation to 47 isolates, 9 Calculated in relation to 24 isolates, 10 Calculated in relation to 38 isolates, 11 Calculated in relation to 68 isolates, 12 Calculated in relation to 28 isolates, 13 Calculated in relation to 67 isolates, 14 Calculated in relation to 87 isolates, 15 Calculated in relation to 69 isolates 16 Calculated in relation to 3 isolates, 17 Calculated in relation to 4 isolates Table 8. Antibiotic susceptibility pro le of fungal organisms…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…is the most common causative organism, however; infections may also be due to other gram positive or gram negative pathogens. 1,12,13 CRBSI can also be complicated by catheter dysfunction and metastatic infections such as endocarditis, osteomyelitis, septic arthritis, and epidural abscess. 10,14 Risk factors for CRBSI include previous catheter-related bacteremia, left-sided internal jugular vein catheters, old age, diabetes mellitus, malnutrition, prolonged use, hypoalbuminemia, and immunosuppression.…”

mentioning

confidence: 99%

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Incidence, Risk Factors and Outcomes of Catheter Related Bloodstream Infections Among Adult Filipino Hemodialysis Patients: A Retrospective Cohort Study

Pasilan,

Tomacruz-Amante,

Dimacali

2023

Preprint

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Background: Despite efforts to improve the management of catheter-related bloodstream infections (CRBSI) in literature, temporary CVCs continue to be used for maintenance hemodialysis outside of acute care settings, particularly in the Philippines. Methods: We conducted a retrospective cohort study to investigate the incidence, outcomes, risk factors, and microbiological patterns of CRBSI among adult kidney disease patients undergoing hemodialysis at the Philippine General Hospital, the country's largest tertiary referral center. We included all adult patients who received a CVC for hemodialysis from January 1, 2018 to August 31, 2019, and followed them for six months to observe the occurrence of CRBSI and its outcomes. Results: Our study documented a CRBSI incidence rate of 6.72 episodes per 1000 catheter days, with a relapse rate of 6.60%, a reinfection rate of 15.74%, and a mortality rate of 6.09%. We identified autoimmune disease, dialysis frequency of > 3x per week, use of CVC for either blood transfusion or IV medications, renal hypoperfusion, drug-induced nephropathy, and hypertensive kidney disease as significant risk factors for CRBSI. Gram-negative bacteria, including Burkholderia cepacia, Enterobacter, and Acinetobacter spp, were the most common organisms causing CRBSI. Multidrug resistant organisms (MDROs) comprised almost half of the isolates (n=89, 44.5%), with Coagulase negative Staphylococcusspecies, having the highest proportion among gram positive organisms and Acinetobacterspp. among gram negative isolates. Conclusion: Our findings emphasize the need for more stringent measures and interventions to prevent the propagation of identified pathogens, such as a review of sterile technique and adequate hygiene practices, continued surveillance, and expedited placement and utilization of long-term access for patients on maintenance hemodialysis. Furthermore, CVC use outside of hemodialysis should be discouraged, and common antibiotic regimens such as piperacillin-tazobactam and fluoroquinolones should be reviewed for their low sensitivity patterns among gram-negative isolates. Addressing these issues can improve outcomes for hemodialysis patients and reduce the burden of CRBSI in our institution.

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Section: Patient Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

Incidence, Risk Factors and Outcomes of Catheter Related Bloodstream Infections Among Adult Filipino Hemodialysis Patients: A Retrospective Cohort Study

Pasilan,

Tomacruz-Amante,

Dimacali

2023

Preprint

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“…I read with interest the article by Abd El-Hamid El-Kady. 1 I would like to add some comments in support of their finding and suggest the criteria for diagnosis of catheter-related bloodstream infection (CRBSI) and performance standards for antimicrobial susceptibility testing needs to be urgently revisited.…”

Section: Dear Editormentioning

confidence: 99%

“…These comments apply not only to the paper by Abd El-Hamid El-Kady 1 but more generally to “all” studies investigating drug resistance either in hospital setting or at home.…”

Section: Dear Editormentioning

confidence: 99%

Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study: An Escape Mechanism Comment [Letter]

Rastmanesh¹

2021

IDR

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I read with interest the article by Abd El-Hamid El-Kady. 1 I would like to add some comments in support of their finding and suggest the criteria for diagnosis of catheter-related bloodstream infection (CRBSI) and performance standards for antimicrobial susceptibility testing needs to be urgently revisited.Looking at their Table 4 "Primary Clinical Presentations and Complications of CRBSIs in Relation to the Causative Organism" it is clear that albeit the authors have correctly applied the latest version of Criteria for Diagnosis of CRBSI (eg 2009Infectious Diseases Society of America (IDSA) diagnostic criteria) 2 and have interpreted antibiotic sensitivity results as per the published criteria of the Clinical and Laboratory Standards Institute (CLSI); 3,4 finding on the correlation between the complications of CRBSI and the causative organism are relatively remote from clinical expectations. This may suggest that these diagnostic criteria and performance standards for antimicrobial susceptibility testing are not inclusive. For instance, cell wall deficiency has been recently proposed as an escape mechanism from phage infection 5 which has not been included in the latest versions of IDSA diagnostic criteria.It is proposed that some bacteria may have complementary mechanisms to escape from phage attack. Furthermore, some bacteria are capable of shedding their cell wall following environmental stresses, yielding cells that temporarily lack a cell wall. In this state, the bacteria may be transiently protected against phages, because they lack the necessary entities that are required for phage binding and consequent infection. Since lack and/or deficiency of cell wall can be triggered by a range of antibiotic administration, phage escape is proposed as an undesirable repercussion 5 that can practically limit the use of phage therapy in special settings like hemodialysis units.These comments apply not only to the paper by Abd El-Hamid El-Kady 1 but more generally to "all" studies investigating drug resistance either in hospital setting or at home.Considering that antibiotic resistance is a major global health problem per se, and bringing in mind the newly emerged viral infections such as the COVID-19, the critical importance of revisiting and updating current standards in the control and spread of antimicrobial resistance and secondary infections should not be underestimated.

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“…Well-functioning vascular access (VA) is a mainstay for performing an efficient HD procedure. 1 There are three main types of access: native arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC) tunneled or non-tunneled catheters. CVCs have become an important procedure for emergencies requiring vascular access and an adjunct in maintaining patients in HD.…”

Section: Introductionmentioning

confidence: 99%

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

Weldetensae¹,

Weledegebriel²,

Tesfahunegn³

et al. 2023

IDR

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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.

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Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study

Cited by 8 publications

References 34 publications

Incidence, Risk Factors and Outcomes of Catheter Related Bloodstream Infections Among Adult Filipino Hemodialysis Patients: A Retrospective Cohort Study

Incidence, Risk Factors and Outcomes of Catheter Related Bloodstream Infections Among Adult Filipino Hemodialysis Patients: A Retrospective Cohort Study

Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study: An Escape Mechanism Comment [Letter]

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

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