Risk factors for catheter-related infection in patients with acute kidney injury undergoing continuous blood...

This study aimed to identify independent risk factors for catheter-related infection (CRI) in patients with acute kidney injury (AKI) undergoing continuous blood purification (CBP) and to provide evidence for its prevention and clinical management.

A retrospective analysis was conducted in 300 AKI patients who received CBP therapy. The incidence of CRI and the distribution of causative pathogens were analyzed. Patients were categorized into a CRI group (n = 38) and a Non-CRI group (n = 262). Potential risk factors were initially evaluated using univariate analysis and subsequently entered into a multivariate logistic regression model to identify independent predictors of CRI. Receiver operating characteristic (ROC) curves were generated to assess the predictive performance of these factors. The 30-day cumulative survival rates were compared using the Kaplan-Meier method with the log-rank test.

Among the 300 patients with AKI who underwent CBP, 38 developed CRI, yielding an incidence of 12.67% (38/300). The identified CRIs comprised 18 bloodstream infections (47.37%), 15 exit-site infections (39.47%), and 5 tunnel infections (13.16%). A total of 44 pathogens were isolated, including 29 Gram-positive bacteria (65.91%), with Staphylococcus aureus (14 isolates, 31.82%) and Staphylococcus epidermidis (7 isolates, 15.91%) being the predominant species; and 15 Gram-negative bacteria (34.09%), predominantly Escherichia coli (7, 15.91%) and Pseudomonas aeruginosa (4, 9.09%). Univariate analysis revealed significant differences between the CRI and Non-CRI groups in age, diabetes, hypoproteinemia, catheter insertion site, number of punctures, and catheter dwell time (P < 0.05). Binary logistic regression identified age ≥ 60 years [2.509 (1.074-5.863)], diabetes [2.154 (0.979-4.739)], hypoproteinemia [1.823 (0.827-4.018)], femoral vein insertion [6.430 (2.655-15.569)], punctures ≥ 1 [3.699 (1.597-8.566)], and dwell time ≥ 10 days [6.251 (2.348-16.644)] as independent risk factors for CRI (P < 0.05). ROC curve analysis showed that the AUCs (95% CIs) for age, catheter insertion site, number of punctures, and dwell time were 0.601 (0.508-0.694), 0.681 (0.593-0.770), 0.615 (0.515-0.714), and 0.688 (0.607-0.770), respectively (P < 0.05). The 30-day all-cause mortality rate was significantly higher in the CRI group (23.91%) than in the Non-CRI group (9.84%) (Log-Rank χ² = 8.055, P = 0.005).

Advanced age, femoral vein catheterization, repeated puncture attempts, and prolonged catheter dwell time were independently associated with an increased risk of CRI in AKI patients undergoing CBP. CRI was associated with markedly poorer 30-day survival, highlighting the importance of early risk assessment and targeted preventive interventions.

Not applicable.