Incidence and challenges in management of hemodialysis catheter-related infections

Area of Science:

• Nephrology
• Infectious Diseases
• Clinical Medicine

Background:

• Catheter-related infections (CRI) pose significant risks for chronic hemodialysis (HD) patients, contributing to morbidity and mortality.
• Understanding the incidence, clinical presentation, and risk factors of CRI is crucial for patient management.

Purpose of the Study:

• To analyze the experience with CRI in a cohort of chronic HD patients.
• To identify clinical characteristics, complications, and predisposing factors for CRI.

Main Methods:

• A retrospective analysis of 49 CRI cases among 167 HD patients over 40 months (January 2018-April 2021).
• Data collection included patient demographics, clinical signs, laboratory results (including CRP and blood cultures), infection complications, and mortality.
• Statistical analysis was performed to identify risk factors, including catheter type, duration of use, and ferritin levels.

Main Results:

• The incidence of CRI was 3.7 per 1000 catheter-days, with fever/chills (90%) and inflammatory signs (74%) as primary symptoms.
• Blood cultures were positive in 65% of cases. Serious complications included infective endocarditis (7 cases) and septic shock (9 deaths).
• Independent risk factors for CRI were longer duration of HD catheter use (p<0.007) and elevated ferritin levels (p<0.0001).

Conclusions:

• CRI is a significant concern in chronic HD patients, associated with severe complications and mortality.
• Prolonged catheter dwell time and elevated ferritin levels are key independent risk factors for CRI.
• Early recognition and management of CRI, alongside strategies to mitigate risk factors, are essential in this vulnerable population.