Emergence of antibiotic resistance in bloodstream infections associated with catheters in hemodialysis patients: a prospective observational study
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Keywords
Catheter related blood stream infection; Cuffed dialysis catheter; Un-cuffed dialysis catheter; Hemodialysis
Abstract
Background: Catheter-related bloodstream infections (CRBSIs) are a significant cause of hospitalization and mortality among hemodialysis patients. Incidence rates and resistance patterns vary widely. Recent studies show a rise in CRBSIs caused by multidrug-resistant organisms (MDROs). This study aims to determine the incidence, microbiological profile, antibiogram and outcomes of CRBSIs in hemodialysis patients at our institution. Methods: This prospective single center observational study included all patients initiating hemodialysis with central venous double-lumen catheters. Results: During the study, 240 catheters were inserted in 240 patients. A total of 48/240 (20%) developed CRBSI with 41/48 (85.4%) having culture-positive probable CRBSI and 07/48 (14.6%) having culture-negative possible CRBSI. Concomitant exit site infection was present in 09/48 (18.8%). The CRBSI incidence rate was 1.46 episodes per 1000 catheter days, based on 48 episodes over 32,782 catheter days. The mean time to CRBSI was 204.6 ± 87.1 days. Gram-positive bacteria were cultured in 15 cases (31.3%), Gram-negative bacteria in 26 cases (54.2%), and 7 cases (14.6%) had negative culture. Coagulase negative Staphylococcus Aureus (CoNS) was the most common Gram-positive pathogens isolated, making up 46.7% of the cases. Klebsiella pneumonia, Pseudomonas, and Acinetobacter species were identified as the most prevalent Gram-negative pathogens (n = 06/26 each; 23.1%. Among 8 cultured Gram-negative bacterial species, resistance patterns observed was Ampicillin: 4/4 tested (100.0%), Quinolones: 4/6 tested (66.7%), Clotrimazole: 3/5 tested (60.0%), Carbapenems: 3/6 tested (50.0%), Gentamicin: 2/5 tested (40.0%), Amikacin: 1/3 tested (33.3%), and Piperacillin-Tazobactam: 1/5 tested (20.0%). A total of 39/48 catheters were salvaged. Conclusions: CRBSI remains a significant issue in patients using central venous catheters. The rise of multidrug-resistant Gram-negative infections necessitates stricter measures, including improved hygiene, surveillance and long-term vascular access. Proper cultures should precede empirical antibiotic therapy, and healthcare centers should tailor their antibiotic policies to local susceptibility patterns.
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Mohammad Bhat, Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
Professor and Head Nephrology, Sheri- Kashmir Institute of medical Sciences
Danish Muqbool, Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
MSC Dialysis Technology, Department of Nephrology, Sheri- Kashmir Institute of medical Sciences
Manzoor Parry, Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
Assistant Professor Nephrology, Sheri- Kashmir Institute of medical Sciences
Amir Farooq, Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
Postdoctoral Trainee, Department of Nephrology, Sheri- Kashmir Institute of medical Sciences
Muzamil Wani, Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
Postdoctoral Trainee, Department of Nephrology, Sheri- Kashmir Institute of medical Sciences
Imran Khan, Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
Postdoctoral Trainee, Department of Nephrology, Sheri- Kashmir Institute of medical Sciences
Imtiyaz Wani, Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
Professor of Nephrology, Sheri- Kashmir Institute of medical Sciences.