Fast and furious: a retrospective study of catheter-associated bloodstream infections with internal jugular nontunneled hemodialysis catheters at a tropical center

Abstract

Background Nontunneled hemodialysis catheters (NTHCs) remain the preferred vascular access at hemodialysis (HD) initiation in developing countries. We studied the incidence, risk factors and microbiological spectrum of jugular NTHC-associated bloodstream infections (CABSIs) at a tertiary care center in South Asia. Methods In this retrospective cohort study, all adult (≥18 years) incident patients who underwent jugular NTHC insertion for HD between January 2016 and June 2017, had no prior history of temporary vascular access insertion and were followed up for ≥14 days were included. Results A total of 897 patients underwent NTHC insertion during the study period and 169 patients fulfilled the inclusion criteria and contributed 7079 patient days of follow-up. CABSI incidence was 7.34 episodes per 1000 catheter days and median infection-free survival and time to CABSI were 96 and 24.5 days, respectively. In multivariate Cox regression analysis, immunosuppressive medication {hazard ratio [HR] 2.87 [95% confidence interval (CI) 1.09–7.55]; P = 0.033} and intravenous cefazolin use [HR 0.51 (95% CI 0.28–0.94); P = 0.031] was independently associated with CABSI. The cumulative hazard of CABSI was 8.3, 13.3, 17.6 and 20.9% at Weeks 1, 2, 3 and 4, respectively. Gram-negative organisms were the most common etiological agents (54.7%) and 40.3% of CABSIs were caused by drug-resistant organisms. Gram-negative and Gram-positive CABSIs were associated with neutrophil left shift and higher procalcitonin compared with coagulase-negative staphylococcal CABSIs. Conclusion In South Asia, NTHC-associated CABSIs occur early and are predominantly Gram negative. We hypothesize that poor hygiene practices may play a role in this phenomenon.

Hemodialysis Catheter-Related Infection in a Teaching Hospital of Central Nepal

“…15 The incidence rate of CRI in our study was 6.94 episodes per 1000 patient days at risk, which is higher than the findings from studies from North America, Europe and Africa (ranging between 1.67 and 5.6/1000 catheter days) [16][17][18] but slightly lower than that reported from India (7.4 episodes per 1000 catheter days). 19 One of the reasons for variation in the findings could be the use of different criteria for Most common clinical features encountered in this study were fever during dialysis, chills and rigor; nausea and vomiting and hypotension, which are in accordance with other few studies. [21][22][23] Significant laboratory parameters among patients with CRI were lower albumin, higher levels of serum ferritin and higher levels of uric acid.…”

Catheter-related bloodstream infections in a nephrology unit: Analysis of patient- and catheter-associated risk factors

“…Only a few articles from emerging countries report a high incidence of Gram− CRBSI in patients with NT CVC, probably due to hospitalization and poor hygiene. 22,34 Another single-center retrospective study including all individuals admitted to non-ICU units, with no mention regarding the proportion of patients undergoing HD, prevalence of underlying renal disease or proportion of T/NT CVCs, reported that underlying neurological disorders and previous antibiotic therapy were associated with higher Gram− CRBSI incidence; no associations with age were found. 35 Among factors associated with CRBSI incidence, we found that NT (vs T) CVC and Femoral (vs Jugular) CVC are independent risk factors for CRBSI.…”

Dialysis vascular access: Where do tunneled catheters stand? – A single-center experience

“…The catheter infection rates for NTHCs have been recently reported as 7.34 episodes per 1000 catheter days in a recent Indian study. [ 20 ] Possible reasons for high CRBSI as well as higher death rates in our study could be low socioeconomic status, suboptimal nutrition, no prophylactic antibiotic lock use and use of TCCs as a “last resort.” Our study setting, where patients were dialyzed at peripheral centers with little to no direct supervision may be an important determinant in this regard. In cases labeled “possible” CRBSI, although such catheters do not meet standard CRBSI definitions, such troublesome catheters are not acceptable to patients, dialysis units, or nephrologists and ultimately contribute to catheter loss.…”