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Catheter-Related Bloodstream Infections Among Hemodialysis Patients in Northern Tanzania: Insights From a
Andrea R Costantine1,2, Sarah J Urasa1,2, Abid M Sadiq1,2
1Department of Internal Medicine Kilimanjaro Christian Medical University College Moshi Tanzania.
Insights
Catheter-related bloodstream infections (CRBSI) affect over half of hemodialysis patients, predominantly caused by gram-positive bacteria. Hypoalbuminemia, diabetes, anemia, and femoral catheters are key risk factors, with vancomycin and meropenem showing high efficacy.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Microbiology
Background:
- Catheter-related bloodstream infections (CRBSI) are severe complications in hemodialysis patients, leading to increased morbidity, mortality, and healthcare costs.
- Limited understanding exists regarding the specific factors contributing to CRBSI and the antibiotic susceptibility patterns of causative pathogens.
Purpose of the Study:
- To investigate the determinants of hemodialysis CRBSI.
- To determine the appropriate antibiogram for bacterial pathogens isolated from hemodialysis patients at KCMC.
Main Methods:
- A retrospective analytical cross-sectional study was conducted on adult hemodialysis patients with central venous catheters from January 2021 to December 2022.
- Data were analyzed using SPSS, with multivariate logistic regression employed to identify factors associated with CRBSI.
Main Results:
- Over half (56.6%) of the 286 analyzed patients developed CRBSI, predominantly caused by gram-positive bacteria (69.7%).
- Significant risk factors included hypoalbuminemia (<35 g/dL), diabetes mellitus, anemia (<10 g/dL hemoglobin), and femoral catheter use.
- Vancomycin demonstrated 99% efficacy against gram-positive isolates, while meropenem showed 82.1% efficacy against gram-negative isolates.
Conclusions:
- Gram-positive bacteria are the primary cause of CRBSI in this hemodialysis cohort, affecting over 50% of patients.
- Identified risk factors are multifactorial, highlighting the need for targeted preventive strategies.
- Effective antibiotic choices include vancomycin for gram-positive and meropenem for gram-negative CRBSI.
Background And Aims:
A catheter-related bloodstream infection (CRBSI) is a life-threatening complication of hemodialysis. It is responsible for significant morbidity and mortality and a costly long hospital stay. Despite its burden, little is known about the factors associated with it and the antibiogram of its responsible causative bacteria. This study aimed to evaluate the determinants of hemodialysis CRBSI and the appropriate antibiogram for the isolated bacterial pathogens among patients attending the KCMC hemodialysis unit.
Methods:
A hospital-based retrospective analytical cross-sectional study involved adult patients with CKD or AKI undergoing hemodialysis at KCMC with tunneled or non-tunneled central venous catheters who attended from January 1, 2021 to December 31, 2022. Data were collected from the hospital's electronic medical record system. Statistical analysis was performed using SPSS version 27. Multivariate logistic regression was used to determine the factors associated with CRBSI. A p-value of < 0.05 was considered statistically significant.
Results:
A total of 286 patients were analyzed. The patients were predominantly males (70.6%), and more than half were above 55 years old (56%), with a mean age of 58 (SD ± 14.8) years. 56.6% developed CRBSI and were predominantly gram-positive (69.7%). Major associated factors were hypoalbuminemia of < 35 g/dL, diabetes mellitus, anemia of hemoglobin < 10 g/dL, and having a femoral central venous catheter. For gram-positive bacteria, the most efficient antibiotic was vancomycin, with an overall average efficacy of 99% for all isolates. For gram-negative bacteria, the most efficient antibiotic was meropenem, with an overall average efficacy of 82.1% for all isolates.
Conclusion:
Over 50% of patients developed CRBSI and gram-positive bacteria were the major causative bacteria. Associated factors were multifactorial and preventive care would be ideal to reduce the number of CRBSI based on these findings.
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