Pattern and Sensitivity of Bacterial Colonization on the Tip of Non-Tunneled Temporary Hemodialysis Catheters: Results of a Tertiary Hospital in Somalia

Abstract

Bacterial colonization on the tip of non-tunneled temporary hemodialysis catheters (NTHCs) and associated catheterrelated infections (CRI) is a common complication in hemodialysis (HD) patients. In this study, we aimed to investigate the pattern of bacterial colonization formed on the tip of non-tunneled temporary hemodialysis catheters and their antibiotic sensitivity. Methods: This retrospective analysis was performed in the HD unit of an Education and Research Hospital that follows up a universe of approximately 300 patients, primarily from Mogadishu, Somalia. From September 2020 to September 2021, a total of 137 temporary HD catheters were removed and their tips were sent for culture after there was a suspicion of CRI and other sources of infection were excluded. HD Catheter tips were cultured semi-quantitatively, and the antibiogram of the positive cultures was studied. Results: Gram-positive cocci were found to be the most predominant bacterial organisms in positive cultures with 27 (31.0%) for Staphylococcus aureus, 9 (10.3%) for Staphylococcus haemolyticus and 5 (5.7%) for Staphylococcus epidermidis. We found Enterococci to be 5.7% of the isolated microorganisms. Gram-negative pathogens isolated included Escherichia coli 13 (14.9%) as the most common, followed by Klebsiella pneumoniae 10 (11.5%) and Acinetobacter baumannii (4.6%). Methicillin-resistant Staphylococcus aureus (MRSA) was found to be 9.4%. Gram-positive isolates showed high sensitivity (100%) to Linezolid, Daptomycin, Vancomycin, and Tigecycline, but a low sensitivity rate to Oxacillin (41.2%). Gram-negative isolates had the highest sensitivity to Tigecycline (100%), Imipenem (88.9%), and Amikacin (87%) but low sensitivity to Ampicillin (4.8%), Trimethoprim/ Sulfamethoxazole (TMP-SMX) (23.1%), and Ceftazidime (7.1%). Conclusion:We conclude that each institution should have its own antibiogram in the management of HD CRIs. According to our findings in this study, we recommend intravenous Vancomycin and Imipenem as empirical therapy in patients with suspected HD CRIs.

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

“…23 According to our study, Staphylococcus aureus and Staphylococcus epidermidis are the most common microorganisms in patients with CVCrelated bacteremia, supported by the results of other studies. 8,[14][15][16][23][24][25] Our study shows that a prior CVC infection is an independent predictor for the development of CVC-related bacteremia in children undergoing h e m o d i a l y s i s . P r e v i o u s s t u d i e s , a s t h e one carried out by Weldetensae et al in a population with CVC, where 93.9% had a nontunneled catheter, demonstrated that a prior infection increased 12 times the probability of developing a subsequent infection.…”

“…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%.…”

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

“…But, in contrary to our ascertained microbial pattern, many studies reported Gram-positive organisms were implicated for majority of the CRBSIs. [11][12][13] Knowing the antibiotics sensitivity pattern of bacterial isolate or growth in HD unit is significant to select the suitable empiric antibiotics. In the current study, more than half of the S. aureus isolates were cloxacillin resistant, in line with this study, Fram and his associates reported that 38.5% of their S. aureus isolates were oxacillin resistant.…”

“…This is similar to the result found by Abdinafi et al which was done in a similar setup in Somalia. 12 Regarding Gram-negative pathogens, they displayed 90% sensitivity to Imipenem, 87% to Amikacin, and 63.3% to…”