Clinico-Microbiological Profile of Catheter Related Blood Stream Infections In Patients on Haemodialysis

Abstract

Introduction: Central venous catheter use in Haemodialysis (HD) is associated with a significant risk of blood stream infection. Knowledge of the etiological agents of Catheter Related Blood Stream Infection (CRBSI) is important for patient care. Aim: To determine the pathogens causing CRBSI and their antimicrobial susceptibility pattern. Materials and Methods: In this prospective study conducted from July to September 2013, fifty adult patients on HD who developed local or systemic signs of catheter related infection were investigated by swab culture from inflamed site (n=20), culture of blood from catheter hub (n=40), catheter tip (n=20) and peripheral venous blood (n=50).Clinical data were analysed to identify risk factors. Results: The frequency of Exit Site Infection (ESI) was 24% and the predominant isolates were Staphylococcus aureus (50%) and Staphylococcus epidermidis (41.7%). Catheter colonisation was detected in 42% of patients. The commonest colonising bacteria were Staphylococccus epidermidis (28.5 %) and Staphylococcus aureus (23.8%). Methicillin resistance was observed in 66.67% and 50% of Staphylococcus aureus isolates associated with ESI and colonisation respectively. CRBSI was diagnosed in 12% of the patients, caused by Pseudomonas aeruginosa (50%) Acinetobacter baumannii (33.3%)and Corynebacterium jeikeium (16.7%). No multidrug resistance was noted.83.3% patients with CRBSI had a precedent catheter colonisation but no ESI. Diabetes mellitus was significantly associated with CRBSI. Conclusion: Gram positive cocci were the predominant catheter colonisers. Gram negative bacilli caused the majority of CRBSI. No precedence of ESI was noted in a significant proportion of CRBSI. Catheter colonisation was a definite forerunner in all the patients.

Keywords

• chronic kidney disease
• vascular access
• blood stream infection