DOI: http://dx.doi.org/10.18203/2349-3933.ijam20163723

Haemodialysis catheter-related blood stream infection in ESRD patients: incidence, outcome and antibiogram of the isolated organisms

Abhilash Chandra, Anupam Das, Manodeep Sen, Divya Srivastava

Abstract


Background: Catheters are used in roughly between 60- 80% of patients at the time of initiation and 25-30% of all prevalent patients as a bridge to permanent vascular access. Relative risk of mortality due to the dreaded complication of bacteraemia is multiple folds higher with the use of haemodialysis (HD) catheters compared to AV fistulas. In the present study we investigate the incidence, causative organisms and the final outcome of catheter related blood stream infections (CRBSI) in haemodialysis patients.

Methods: It was a retrospective cross-sectional study carried in a tertiary care hospital in north India which included adult (>18 years) ESRD patients with the diagnosis of HD CRBSIs in a duration of 2 years.

Results: Forty two cases of infection were reported in 39 subjects. In the temporary uncuffed catheter (TUC) group expired patients were older, had lower haemoglobin levels and longer hospital stay although none was significant. In the permanent cuffed catheter group expired patients had longer hospital stay, lower haemoglobin levels. Catheter removal was significantly more in TUCs and salvageability was significantly more in PUCs (p = 0.0035). The rise in Acinetobacter and Citrobacter positive cases and the growing resistance against third generation cephalosporin, carbapenems was a notable phenomenon amongst gram negative organisms.

Conclusions: Hemodialysis patients with catheter as vascular access presenting with fever, the first differential diagnosis is CRBSI. They can be managed on an outpatient basis barring those with evidence of severe sepsis. Early removal of temporary uncuffed catheters can give good results in selected patients.


Keywords


Antibiogram, CRBSI, Haemodialysis

Full Text:

PDF

References


Kairaitis LK, Gottlieb T. Outcome and complications of temporary haemodialysis catheters. Nephrol Dial Transplant. 1999;14:1710-4.

Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int. 2000;58:2543-5.

Saad TF. Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis. 1999;34:1114-24.

Ashwani RS, Mercia RS, Kenneth EC, Richard C, Jeanette AC. Use of standardarized ratios to examine viability in haemodialysis vascular access across facilities. Am J Kidney Dis. 2000;35:275-81.

Jaar BG, Herman JA, Furth SL, Briggs W, Powe NR. Septicemia in diabetic haemodialysis patients: Comparison of incidence, risk factors and mortality with non-diabetic patients. Am J Kidney Dis. 2000;35:282-92.

Munshi SK, Narayanaswami VK, Nicholas AT, Harneeta B, Nelson TC, Graham W. Outcome of renal replacement therapy in the very elderly. Nephrol Dial Transplan. 2001;16:128-33.

Powe NR, Jaar B, Furth SL, Hermann J, Briggs W. Septicemia in dialysis patients incidence, risk factors, and prognosis. Kidney Int. 1999;55:1081-90.

Hoen, B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: A multicentre prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998;9:869-76.

Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J. Type of vascular access and survival among incident hemodialysis patients: the choices for healthy outcomes in caring for ESRD (CHOICE) Study. J American Soci Nephrol. 2005;16(5):1449-55.

United States Renal Data System 1999 Annual Data Report: part IX. Hospitalization in ESRD. Am J Kidney Dis. 1999;34:114-23.

Liu JW, Su YK, Liu CP, Chen JB. Nosocomial blood-stream infections in patients with end-stage renal disease; excess length of hospital stay, extra cost and attributed mortality. Hosp Infect. 2002;50:224-7.

Bouza E, Alvarado N, Alcal L, Perez MJ, Rincon C, Munoz P. A randomized and prospective study of 3 procedures for the diagnosis of catheter-related bloodstream infection without catheter withdrawal, Clin Infect Dis. 2007;44(6):820-6.

Vanholder R, Canaud B, Flucketal R. Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP). NDT Plus. 2010;3(3):234-6.

Mermel LA, Allon M, Bouza E, Craven DE, Patricia Flynn, O’Grady NP, et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1-45.

Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296:1305-9.

Marr KA, Saxton DJ, Conlon PJ, Corey GR, Schwab SJ, Kirk-land KB. Catheter related bacteremia and outcome attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med. 1997;127:275-80.

Vascular Access 2006 Work Group Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(1):176-247.

Jean G, Charra B, Chazot C, Vanel T, Terrat JC, Hurot JM, et al. Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias. Nephron. 2002;91(3):399-405.

Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J. Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol. 2003;14:169-79.

Beathard GA. Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol. 1999;10:1045-9.

Poole CV, Carlton D, Bimbo L, Allon M. Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen. Nephrol Dial Transplant. 2004;19:1237-44.

Marr KA, Kong LK, Fowler VG, Gopal A, Sexton DJ, Conlon PJ, et al. Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int. 1998;54:1684-9.

Krishnasami Z, Carlton D, Bimbo L, Taylor ME, Balkovetz DF, Barker J, et al. Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution. Kidney Int. 2002;61:1136-42.

Mokrzycki MH, Zhang M, Cohen H, Golestaneh L, Laut JM, Rosenberg SO. Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant. 2006;21:1024-31.

Alexandraki I, Sullivan R, Zaiden R, Bailey C, McCarter Y, Khan A, et al. Blood culture isolates in hemodialysis vascular catheter-related bacteremia, American J Med Sci. 2008;336(4):297-302.

Velasco E, Byington R, Martins CSA, Schirmer M, Dias LCM, Goncalves VMSC. Bloodstream infection surveillance in a cancer centre: a prospective look at clinical microbiology aspects, Clin Microbiol Infect. 2004;10(6):542-9.

Velasco E, Byington R, Martins CAS, Schirmer M, Dias LMC, Goncalves VMSC. Comparative study of clinical characteristics of neutropenic and non-neutropenic adult cancer patients with bloodstream infections. Eur J Clin Microbiol Infect Dis. 2006;25(1):1-7.

MakiandL D, Mermel A. Infections due to infusion therapy, in Hospital Infections. In: Bennettand J, Brachman P, Eds. Philadelphia, PA, USA: Lippincott-Raven; 1998: 689-724.

Alexandraki IB, Plott DT. Hemodialysis vascular catheter-related bacteremia: five year epidemiologic shift in organism isolates. J American Soci Nephrol. 2005;16:435.

Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30:62-7.

Dobbins BM, Kite P, Kindon A, McMahon MJ, Wilcox MH. DNA fingerprinting analysis of coagulase negative staphylococci implicated in catheter related bloodstream infections. J Clin Pathol. 2002;55:824-8.

Anaissie E, Samonis G, Kontoyiannis D, Costerton J, Sabharwal U, Bodey G, et al. Role of catheter colonization and infrequent hematogenous seeding in catheter-related infections. Eur J Clin Microbiol Infect Dis. 1995;14:134-7.

Raad II, Luna M, Khalil SA, Costerton JW, Lam C, Bodey GP. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA. 1994;271:1014-6.

Herrmann M, Suchard SJ, Boxer LA, Waldvogel FA, Lew PD. Thrombospondin binds to Staphylococcus aureus and promotes staphylococcal adherence to surfaces. Infect Immun. 1991; 59:279-88.

Nielsen J, Ladefoged SD, Kolmos HJ. Dialysis catheter-related septicaemia–focus on Staphylo-coccus aureus septicaemia. Nephrol Dial Transplant. 1998;13:2847-52.

Johnson LB, Jose J, Yousif F, Pawlak J, Saravolatz LD. Prevalence of colonization with community-associated methicillin-resistant Staphylococcus aureus among end-stage renal disease patients and healthcare workers. Infect Control Hosp Epidemiol. 2009;30:4-8.

Boelaert JR, De Smedt RA, De Baere YA, Godard CA, Matthys EG, Schurgers ML, et al. The influence of calcium mupirocin nasal ointment on the incidence of Staphylococcus aureus infections in haemodialysis patients. Nephrol Dial Transplant. 1989;4:278-81.

Adeniyi OA, Tzamaloukas. Relation between access-related infection and pre-infection serum albumin concentration in patients on chronic hemodialysis. Hemodial Int. 2003;7:304-10.

Pecoits-Filho R, Landholm B, Stenvinkel P. The malnutrition, inflammation and atherosclerosis (MIA) syndrome. Nephrol Dial Transplant. 2002;17:28-31.

Tanriover B, Carlton D, Saddekni S, Hamrick K, Oser R, Westfall AO, et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int. 2000;57:2151-5.

Descamps-Latscha B, Drüeke T, Witko-Sarat V. Dialysis-induced oxidative stress: biological aspects, clinical consequences, and therapy. Semin Dial. 2001;14:193-9.

Meier P, Payer E, Blanc E, Wauters JP. Early T-cell activation correlation with expression of apoptosis markers in patients with end stage renal disease. J am Soc Nephrol. 2002;13:204-12.

Robinson DL, Fowler WG, Saxton DJ. Bacterial endocarditis in hemodialysis patients. Am J Kidney Dis. 1997;30:521-4.

Kovalik EC, Raymond JR, Albers FJ, Berkoben M, Butterly DW, Montella B. A clustering of epidural abscesses in chronic hemodialysis patients: risks of salvaging access catheters in case of infection. J Am Soc Nephrol. 1996;7:2264-7.

Negulescu O, Coco M, Croll J, Mokrzycki MH. Large atrial thrombus formation associated with tunneled cuffed hemodialysis catheters. Clin Nephrol. 2003;59:40-6.

Mokrzycki MH, Zhang M, Cohen H, Golestaneh L, Laut JM, Rosenberg SO. Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant 2006;21:1024-31.

Al-Solaiman Y, Estrada E, Allon M. The Spectrum of Infections in Catheter-Dependent Hemodialysis Patients. Clin J Am Soc Nephrol. 2011;6(9):2247-52.

NKF-DOQI Clinical Practice Guidelines for vascular access update. National Kidney Foundation. New York Guideline. 2000;26:25-8.