Incidence, Risk Factors and Outcomes of Catheter Related Bloodstream Infections Among Adult Filipino Hemodialysis Patients: A Retrospective Cohort Study

Abstract

Background: Despite efforts to improve the management of catheter-related bloodstream infections (CRBSI) in literature, temporary CVCs continue to be used for maintenance hemodialysis outside of acute care settings, particularly in the Philippines. Methods: We conducted a retrospective cohort study to investigate the incidence, outcomes, risk factors, and microbiological patterns of CRBSI among adult kidney disease patients undergoing hemodialysis at the Philippine General Hospital, the country's largest tertiary referral center. We included all adult patients who received a CVC for hemodialysis from January 1, 2018 to August 31, 2019, and followed them for six months to observe the occurrence of CRBSI and its outcomes. Results: Our study documented a CRBSI incidence rate of 6.72 episodes per 1000 catheter days, with a relapse rate of 6.60%, a reinfection rate of 15.74%, and a mortality rate of 6.09%. We identified autoimmune disease, dialysis frequency of > 3x per week, use of CVC for either blood transfusion or IV medications, renal hypoperfusion, drug-induced nephropathy, and hypertensive kidney disease as significant risk factors for CRBSI. Gram-negative bacteria, including Burkholderia cepacia, Enterobacter, and Acinetobacter spp, were the most common organisms causing CRBSI. Multidrug resistant organisms (MDROs) comprised almost half of the isolates (n=89, 44.5%), with Coagulase negative Staphylococcusspecies, having the highest proportion among gram positive organisms and Acinetobacterspp. among gram negative isolates. Conclusion: Our findings emphasize the need for more stringent measures and interventions to prevent the propagation of identified pathogens, such as a review of sterile technique and adequate hygiene practices, continued surveillance, and expedited placement and utilization of long-term access for patients on maintenance hemodialysis. Furthermore, CVC use outside of hemodialysis should be discouraged, and common antibiotic regimens such as piperacillin-tazobactam and fluoroquinolones should be reviewed for their low sensitivity patterns among gram-negative isolates. Addressing these issues can improve outcomes for hemodialysis patients and reduce the burden of CRBSI in our institution.