Pattern of bacterial bloodstream infections in hemodialysis patients

Bloodstream infection (BSI) is a major contributor to morbidity and mortality in hemodialysis patients. Our objective was to identify pathogens causing BSI, its incidence, and associated risk factors.

Retrospective positive blood culture data were analyzed from five hemodialysis centers (January 2019 until December 2023) across Saudi Arabia.

There were 437 bacteremia episodes in 432 patients, with 405 central line and 367 peripheral samples. The BSI rate was 0.67 per 100 patient months. 375 (85.8%) patients had a Central Venous Catheter (CVC), 27 (6.17%) had an arteriovenous fistula (AVF), 5 (1.14%) had an arteriovenous graft (AVG), and 30 (6.9%) had dual access. The central line-associated bloodstream infection (CLABSI) rate was 1.41 per 100 patient months. Gram-positive organisms in the central line blood culture were 169 (44%), and Gram-negative were 200 (51.81%); 16 (4%) cases were polymicrobial, and there was one case of fungi. In peripheral blood cultures, 158 (48.9%) were Gram-positive and 150 (46.4%) were Gram-negative. The most common pathogens were Staphylococcus aureus, MRSA, and Staphylococcus epidermidis in Gram-positive organisms, and Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas aeruginosa in Gram-negative organisms. Three cases of fungal infection occurred during the study period. Two-thirds of patients (68%) required hospital treatment, and in 54% of the cases, there was loss of vascular access. Mortality due to sepsis within 4 weeks occurred in five patients.

The risk of BSI in hemodialysis patients is high. Gram-negative pathogens contribute to half of the events. In Saudi Arabia, Gram-negative pathogen incidence is significant, and measures are required to curtail it.