Central venous catheter-related bacteremia in chronic hemodialysis patients: Saudi Single Center Experience

Abstract

Central vein catheters (CVC) are an important means of delivering hemodialysis (HD) to patients who require immediate initiation of dialysis but are without a mature functioning arterio-venous fistula or graft. The frequency of catheter-related bacteremia (CRB) reported in several large series ranged between 2.5 and 5.5 cases/1,000catheter-days. The aim of the study was to evaluate the incidence, spectrum of infecting organisms, risk factors, and optimal treatment for catheter-related bacteremia.This retrospective study of clinical records was conducted between January 2005 and January 2009 where all episodes of catheter related bacteremia in the preceding 4 years were a subject of our study. Data recorded for each patient included the number of catheter-days, episodes of suspected bacteremia, blood culture results, method of treatment, complications, and outcomes. All patients with CRB were treated with a 21-day course of intravenous antibiotics, with surveillance cultures obtained 1 week after completing the course of antibiotics. The CVC was removed if the patient had uncontrolled sepsis or if other vascular access was ready for use. Once the infection was controlled, catheter salvage was considered successful, leaving the original CVC in place. 93 chronic hemodialysis (HD) patients, 42 male (45.25%) and51 female (54.8%) were included, with median age51.67 years. During this study, there were 37087catheter-days, with 52 episodes of CRB, or 1.4 episodes/1,000 catheter-days. Thirty- five infections (67.3%) were caused by gram-positive cocci only, including Staphylococcus aureus, Staphylococcus simulans, and Staphylococcus haemolyticus. Seventeen infections (32.7%) were caused by gram-negative rods only, including a wide variety of enteric organisms. Five CVCs were removed because of severe uncontrolled sepsis, of the remaining 47 cases; attempted CVC salvage was successful in (90.3%). The only important complication of CRB was endocarditis, occurring in 1 of 52 episodes (1.9%). We conclude that in our study, CRB is relatively near the lower limit of normal range with low incidence of complication and frequently involves gram-positive bacteria. CVC salvage is significantly improved when CVC was treated by antibiotic based on blood culture results.

Keywords

• Catheter, hemodialysis, Saudi

Central venous catheter-related bacteremia in chronic hemodialysis patients: Saudi Single Center Experience

Öz

Santral ven kateterler (SVK) diyaliz ihtiyacı olup olgun iyi çalışan arteriyovenöz fistül veya grefti olmayan hastalarda hemodiyalizin başlatılması için gerekli bir araçtır. Birçok büyük seride kateterle ilişkili bakteremi (KİB) sıklığı 2.5 ile 5.5 vaka / 1,000 kateter-gün arasında değiştiğini bildirilmiştir.Çalışmanın amacı, enfekte organizmaların sıklığı, spektrumu, risk faktörleri, ve kateterle ilişkili bakteriyemi için optimal tedaviyi değerlendirmektir. Bu retrospektif çalışma Ocak 2005 ve 2009 arasındaki 4 yıl içinde kateter ilişkili bakteriyemi saptanan tüm vakaların klinik verilerin değerlendirilmesini içermektedir. Kaydedilen veriler her hasta için kateter gün sayısını, şüpheli bakteriyemi episodlarını, kan kültür sonuçlarını, tedavi yöntemini, komplikasyonları ve sonuçları içermektedir. KİB olan tüm hastalar intravenöz antibiyotik ile 21 gün tedavi edildi ve 1 hafta sonra sürveyans kültürü alındı. Hastada kontrol altına alınamayan sepsis veya kullanıma hazır diğer vasküler giriş olduğu durumlarda SVK çıkarıldı. Enfeksiyonun kontrol altına alındığı olgularda orjinal SVK yerinde bırakıldı. 42 erkek (45.25%), 51 kadın ve ortalama yaşları 51.67 yıl olan toplam 93 kronik hemodiyaliz hasta çalışmaya dahil edildi. Çalışma süresince 52 KİB ile birlikte olan 37087 kateter-gün veya 1.4 episod/1000 kateter-gün tespit edildi. 35 infeksiyon vakasında (%67.3) etken Staphylococcus aureus, Staphylococcus simulans, and Staphylococcus haemolyticusu içeren gram pozitif mikroorganizmalar olarak tespit edildi. 17 infeksiyonda (%32.7) etken enteric organizmaları da kapsayan gram negatif çomaklardı. 5 adet SVK ciddi kontrol altına lınamayan sepsis nedeniyle çıkarılırken geriye kalan 47 (%90.3) vakada orjinal kateterler başarı ile kullanılmaya devam edildi. 42 episodun bir tanesinde (%1.9) ciddi bir komplikasyon olan endokardit gelişti. Çalışmamızın sonuçlarına göre KİB nispeten düşük komplikasyon sıklığı ile birliktedir ve sıklıkla gram pozitif bakterileri içeren mikroorganizmalar bu durumdan sorumludur. Kan kültür sonuçlarına göre uygun antibiyotik kullanıldığı takdirde SVK kurtarılabilmektedir

Anahtar Kelimeler

• Kateter, hemodiyaliz, SuudiPrince Salman center for kidney disease, Riyadh, Kingdom of Saudi Arabia1 Man

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