RENAL DATA FROM THE ARAB WORLD
Year : 2009 | Volume
: 20 | Issue : 6 | Page : 1091--1095
Catheter related infection in hemodialysis patients
Zahid Nabi, Saifal Anwar, Majda Barhamein, Hachem Al Mukdad, Abdallah El Nassri
Department of Medicine, Nephrology Division, King Fahd Specialist Hospital, Buraida, Al Qassim, Saudi Arabia
Assistant Consultant Nephrology, King Faisal Specialist Hospital & Research center, Riyadh
To determine the frequency of hemodialysis (HD) catheter related infection, causative microorganisms and predisposing factors contributing to these infections at our center, we conducted a prospective study in 2007 involving 57 (45.6% males) patients in whom a temporary catheter was inserted for HD. The patients were followed for one month to document any episodes of hemodialysis catheter related infection (HCRI). There were 11 (19.3%) patients who developed HCRI proven by blood culture; 5 patients were infected with more than one organism. Staphylococcus Coagulase negative and Staphylococcus aureus (S. aureus) remain the most common pathogens. All the organisms were sensitive to antibiotics administered empirically, however, 3 patients developed multiple resistant S. aureus (MRSA). All the infected patients experienced previous episodes of HCRI, which formed a risk factor in addition to low albumin when compared to the noninfected group (P=0.024 and P= 0.001, respectively). We conclude that the rate of HCRI and the causative organisms found in our study is comparable to previous reports. We still need to adopt measures to minimize the use of temporary vascular accesses by creation of fistulas in a timely fashion.
|How to cite this article:|
Nabi Z, Anwar S, Barhamein M, Al Mukdad H, El Nassri A. Catheter related infection in hemodialysis patients.Saudi J Kidney Dis Transpl 2009;20:1091-1095
|How to cite this URL:|
Nabi Z, Anwar S, Barhamein M, Al Mukdad H, El Nassri A. Catheter related infection in hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Apr 2 ];20:1091-1095
Available from: http://www.sjkdt.org/text.asp?2009/20/6/1091/57275
IntroductionPatients with renal failure undergoing hemodialysis (HD) are known to be at increased risk of infection. Various risk factors may predispose to infection including the underlying disease, the uremic state, and the dialysis procedure itself.  Sepsis is the second most common cause of death in hemodialysis patients after cardiovascular disease. 
Temporary catheters are designed for shortterm use in HD patients who do not have permanent accesses for dialysis. Catheter related infections may be classified as bacteremia or exit site/tunnel infections.  Exit site and tunnel infections may predispose to bacteremia via extra luminal colonization of the catheter.
Central venous catheter related blood stream infection is a major cause of morbidity and mortality in HD patients.  The majority of bacteremias are caused by the vascular accesses, with the incidence being 10 times greater with indwelling catheters than either fistulas or synthetic grafts. ,, The risk factors for catheter infection include prolonged duration of usage, a history of previous catheter-related bacteremia, recent surgery, diabetes mellitus, iron overload, Staphylococcus aureus nasal colonization, old age, and low hemoglobin and serum albumin levels. ,, Determining risk factors of catheter associated infections may aid in its prevention and subsequently lower therapeutic cost and improve patient survival and quality of life. 
In this study, we aimed to determine the frequency of HD catheter related infection, causative microorganisms, and predisposing factors contributing to these infections at our center.
Materials and Methods
This prospective study was conducted in hemodialysis patients at King Fahd Specialist Hospital, Buraida, Al-Qassim, Saudi Arabia during year 2007.
All HD patients with temporary catheters inserted for more than one week were included in this study. The patients were followed up for one month after insertion of catheter for any evidence of hemodialysis catheter related infection (HCRI). Catheter related bacteremia was suspected when a patient experienced fever, chills, purulent discharge from catheter site, erythema or tenderness over exit site, in the absence of any other focus of infection. The patients with clinical or laboratory evidence of another focus of infection were excluded from study.
Central and peripheral blood cultures were sent immediately for suspected HCRI followed by initiation of empiric antibiotic therapy which included vancomycin and ceftazidime.
Data analysis was performed using the SPSS version-10.0. Frequency and percentages were computed to present categorical variables such as catheter related infection, causative microorganisms, gender, history of catheter related infection, causes of ESRD, blood C/S and biochemical parameters categorized as per standard normal range. Logistic regression analysis was performed to compare these categorical response variables between the group of patients with and without catheter related infection. All continuous response variables such as patient's age, biochemical parameters were presented as the mean ± SD; Student's "t" test was applied to compare the means of these variables between two groups. Statistical significance was considered as P  Our results documented the high rate of HCRI (19.3%) with temporary non cuffed non tunneled catheters as mentioned in the literature. ,, The percentage is a little higher in our study than that found by Oliver et al  but at the same time we did not classify infection rate according to the anatomic site as done by them. The difference in rate of HCRI according to anatomic site has recently been negated by Parienti et al who demonstrated that jugular venous access does not reduce the risk of infection as compared with femoral catheters. 
Coagulase -ve S. hemolyticus and S. aureus were the most common causative organisms in our study, which is comparable to the prospective trial performed by Dopairak et al,  Kairaitis et al  and Blakestijin.  Our study confirmed association of low albumin level and previous epi sodes of catheter related infection as predisposing risk factors for HCRI. Hypoalbuminemia was also found to be a risk factor for HCRI by Tanriover B et al.  Interestingly our study did not demonstrate leukocytosis in the HCRI patients in contrast to what has been reported before. 
Our study has few limitations, the number of patients was small and we did not classify infection rate and outcome according to anatomic site. We also did not correlate the association of nasal S. aureus carriage to HCRI as mentioned by Jean et al  who noted in their study that 35% of the patients had positive nasal carriage of S. aureus; the range is from 20 to 58%. 
We conclude that the rate of HCRI and the causative organisms found in our study is comparable to previous reports. We still need to adopt measures to minimize the use of temporary vascular accesses by creation of fistulas in a timely fashion.
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