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Pattern Of Causative Micro-Organisms In Catheter Related Blood Stream Infections In Dialysis Patients: Experience
1Department of Medicine, Nephrology Division, King Fahd Hospital, Hofuf, Kingdom of Saudi Arabia.
Insights
Gram-negative bacteria, particularly Enterobacter cloacae, commonly cause catheter-related bloodstream infections (CRBSI) in hemodialysis patients. Diabetics, males, and middle-aged individuals showed higher CRBSI susceptibility.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Catheter-related bloodstream infections (CRBSI) are a major cause of morbidity in hemodialysis (HD) patients, primarily linked to HD catheters.
- Limited regional data exists on the specific microbial agents causing CRBSI, necessitating local investigation.
Purpose of the Study:
- To identify and characterize the microbial agents responsible for CRBSI in hemodialysis patients within a specific region.
- To determine the prevalence of different microorganisms causing CRBSI and analyze their association with patient demographics and comorbidities.
Main Methods:
- A prospective observational survey was conducted over 26 months (Nov 2014 - Jan 2017) at King Fahd Hospital, Hofuf, KSA.
- Blood cultures were obtained from hemodialysis patients presenting with CRBSI features.
- Microorganisms were identified, and their prevalence was stratified by patient age, gender, and comorbidities.
Main Results:
- A total of 210 CRBSI episodes were documented.
- Gram-negative microorganisms (61.5%) were more prevalent than Gram-positive microorganisms (38.5%).
- Key pathogens included Coagulase-Negative Staphylococcus aureus (53 episodes), Enterobacter cloacae (28), and Pseudomonas (19).
- CRBSI incidence was higher in males (n=136), diabetics (n=113), and individuals around 40 years old (n=97).
Conclusions:
- Gram-negative bacteria, notably Enterobacter cloacae, are the predominant cause of CRBSI in this Saudi Arabian population.
- This finding differs from other studies, highlighting regional variations in CRBSI etiology.
- Diabetics, males, and the middle-aged demographic exhibit increased susceptibility to CRBSI, warranting targeted preventive strategies.
Background:
Catheter related blood stream infections (CRBSI) are the leading cause of morbidity in HD patients. The majority of these infections relate to haemodialysis catheters. There is a paucity of local data on microbial agents responsible for CRBSI in our region. This prompted our study.
Methods:
This Prospective observatory survey was conducted in Department of Nephrology, King Fahd Hospital, Hofuf KSA from Nov 2014 to Jan 2017 (26 months). It was performed on dialysis patients with HD catheters who developed features of CRBSI. Blood cultures were taken from the patient and cultured microorganisms were observed and stratified according to type and prevalence in relation to age gender and comorbidities.
Results:
There were 210 distinct episodes of CRBSI. 61.5% (n=129) were due to gram negative microorganisms and 38.5% (n=81) were due to Gram positive microorganism. Fifty-three events were due to Coagulase Negative Staphylococcus aureus. Enterobacter cloachae accounted for 28 events. Pseudomonas 19 events, Enterococcus faecalis 13, Klebsiella 11, Acinitobacter accounted for 8 events. CRBSI was observed more frequently in males (n=136), diabetics (n=113) and in age 40 years±19 years(n=97).
Conclusions:
Gram negative microorganisms were more commonly responsible for CRBSI in our settings. Enterobacter cloachae was most common gram-negative microorganism responsible for CRBSI, a finding not observed in other studies. There was significant predisposition to diabetics, male gender and middle age group. We need further studies to observe antibiotics sensitivity of microorganisms so that we can standardize empirical antibiotics in cases of CRBSI.
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