Frequency of catheter related infections in haemodialysed uraemic patients

To investigate the incidence of bacteraemia and bacterial colonization related to the use of dual-lumen catheters in ESRD patients on haemodialysis.

Sixty patients with ESRD of varied etiologies, both males and females falling in the age range (16-74 years) were randomly selected. Non-cuffed, non-tunneled polyurethane double lumen catheters were inserted under aseptic technique. Patients on twice a week schedule of haemodialysis were followed up for a period of 5 months. After every haemodialysis session, catheters were examined for any local infection or signs of bacteraemia. In case of suspicion, distal 5 cm segment of the catheter, and local pus swab and two blood culture samples were sent to the pathology laboratory.

Thirty one catheters (51.6%) sent for culture and sensitivity showed colonization (> 15 CFU). Bacteraemia was positive in 15 (25%) patients. Thirteen (41.9%) catheter tips were found to be colonized by staphylococcus epidermidis, eleven (35.4%) by staphylococcus aureus, three (0.96%) by Candida albicans species, two (6.45%) by E coli, one (3.2%) by P Aeruginosa and one (3.2%) by mixed Pseudomonas and E coli respectively.

Non cuffed non tunneled double lumen catheters are designed for short-term emergency use and should be used in the same context. Although pathogenesis of catheter related infection is multifactorial the transcutaneous migration of organisms colonizing the skin remains the most important route.