CATHETER-RELATED BLOODSTREAM INFECTION AMONG HEMODIALYSIS PATIENTS: INCIDENCE AND MICROBIOLOGICAL PROFILE
Bryar E. Nuradeen a, Sherko A. Omer b, Dana A. Sharif c, and Tara S. Othman d
a Kurdistan Board Medical Studies Candidate, Public Health Laboratory, Sulaimani Directorate of Health.
b Department of Microbiology, College of Medicine, University of Sulaimani.
c Department of Medicine, College of Medicine, University of Sulaimani.
d Bacteriology Laboratory, Shar Hospital, Sulaimani Directorate of Health.
Submitted: 7/4/2018; Accepted: 11/9/2018; Published 21/12/2018
DOI Link: https://doi.org/10.17656/jsmc.10173
Catheter-related bloodstream infections are the most serious infection complication among hemodialysis patients.
To identify the incidence of catheter-related bloodstream infections among hemodialysis patients in Sulaimani city. Also to find the relationship of infection with the catheter type, site, and duration, and to identify the causative organisms and their antimicrobial susceptibility.
A cross-sectional observational study done in hemodialysis patients suspected to have catheter-related bloodstream infections. Two blood samples (from peripheral vein and catheter lumen) were cultured aerobically on blood culture media. Removed catheters were also cultured aerobically to detect catheter colonization. Isolates were identified based on cultural characteristic, microscopy, biochemical profile and Vitek® 2 system. Antimicrobial susceptibilities test done using Kirby-Bauer method.
A total 117 patients suspected to have catheter-related bloodstream infections were included from two dialysis centers (49 from Shar center and 68 from Qirga center). These patients experienced 164 suspected infection episodes, of these, 146 (89%) yielded bacterial growth giving infection incidence of 24.95 per 1000 dialysis-sessions through different catheters. Coagulase-negative staphylococci were the commonest isolates in both centers, 51.5% and 19.3% in Shar and Qirga center respectively followed by S. aureus (25.7%) in Shar and pseudomonas spp. (15.8%) in Qirga center. Catheter colonization was caused by coagulase-negative staphylococci (39.1%) in Shar and Pseudomonas spp. (23.3%) in Qirga. Linezolid, tigecycline and teicoplanin were most effective against most gram-positive bacteria. Likewise, ampicillin-sulbactam and piperacillin-tazobactam were effective against most of the gram-negative isolates. None of the empirically used antibiotics, vancomycin and gentamicin, was fully effective against all the isolates.
Incidence of catheter-related bloodstream infections is high in Sulaimani dialysis centers. The dialysis centers revealed different isolates but mainly staphylococci and pseudomonas spp. Prolong empirical antimicrobial use is not recommended and such infections should be treated according to the antimicrobial susceptibility results. Infection was less with permanent tunneled catheters compared to temporary catheters, however, temporary hemodialysis catheter inserted to internal jugular vein showed less chance of infection than in subclavian and femoral vein catheters.
Hemodialysis, Central venous catheters, Catheter-related bloodstream infection, Sulaimani.
1. Leone S, Suter F. Severe bacterial infections in haemodialysis patients. Infez Med. 2010;18(2):79-85.
2. Gilmore J. KDOQI clinical practice guidelines and clinical practice recommendations--2006 updates. Nephrol Nurs J. 2006;33(5):487-8.
3. Lata C, Girard L, Parkins M, James MT. Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review. Can J Kidney Health Dis. 2016;3:24.
4. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. 2001;60(4):1443-51.
5. Bohlke M, Uliano G, Barcellos FC. Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment. J Vasc Access. 2015;16(5):347-55.
6. Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al. Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis. 2016;3:1-11.
7. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30(1):62-7.
8. Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014;4(2):162-7.
9. Bates DW, Pruess KE, Lee TH. How bad are bacteremia and sepsis? Outcomes in a cohort with suspected bacteremia. Arch Intern Med. 1995;155(6):593-8.
10. Napalkov P, Felici DM, Chu LK, Jacobs JR, Begelman SM. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis. BMC Cardiovasc Disord. 2013;13:86.
11. Hammarskjold F, Wallen G, Malmvall BE. Central venous catheter infections at a county hospital in Sweden: a prospective analysis of colonization, incidence of infection and risk factors. Acta Anaesthesiol Scand. 2006;50(4):451-60.
12. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-33.
13. Pinon M, Bezzio S, Tovo PA, Fagioli F, Farinasso L, Calabrese R, et al. A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. Eur J Pediatr. 2009;168(12):1505-12.
14. Fysaraki M, Samonis G, Valachis A, Daphnis E, Karageorgopoulos DE, Falagas ME, et al. Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis. Int J Med Sci. 2013;10(12):1632-8.
15. Vandecasteele SJ, Boelaert JR, De Vriese AS. Staphylococcus aureus infections in hemodialysis: what a nephrologist should know. Clin J Am Soc Nephrol. 2009;4(8):1388-400.
16. Morales M, Mendez-Alvarez S, Martin-Lopez JV, Marrero C, Freytes CO. Biofilm: the microbial "bunker" for intravascular catheter-related infection. Support Care Cancer. 2004;12(10):701-7.
17. Donlan RM. Biofilms: microbial life on surfaces. Emerg Infect Dis. 2002;8(9):881-90.
18. Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS. 2017;125(4):365-75.
19. 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(6):1091-5.
20. Gupta S, Mallya SP, Bhat A, Baliga S. Microbiology of Non-Tunnelled Catheter-Related Infections. J Clin Diagn Res. 2016;10(7):DC24-8.
21. Marcos M, Soriano A, Inurrieta A, Martinez JA, Romero A, Cobos N, et al. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens. J Antimicrob Chemother. 2011;66(9):2119-25.
22. Tille PM. Bloodstream Infections. Bailey & Scott's DIAGNOSTIC MICROBIOLOGY. Fourteenth ed. Canada: ELSEVIER; 2017. p. 924-41.
23. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45.
24. Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296(23):1305-9.
25. England PH. UK Standards for Microbology Investigations. Investigation of Intravascular cannulae and associated specimens2015. p. 1-24.
26. PM C. Identification of Gram-Positive Organisms. In: Emanuel Goldman LHG, editor. Practical Handbook of Microbiology. Second ed: Boca Raton CRC Press; 2009. p. 53-66.
27. Donna J. Kohlerschmidt KAM, Dumas NB. Identification of Gram-Negative Organisms In: Emanuel Goldman LHG, editor. Practical Handbook of Microbiology. Second ed: Boca Raton: CRC Press; 2009. p. 67-79.
28. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966;45(4):493-6.
29. CLSI CALSI. M100-S24 Performance Standards for Antimicrobial Susceptibility Testing; Twenty Fourth Informational Supplement. USA2014.
30. de Freitas LW, Neto MM, Nascimento MM, Figueiredo JF. Bacterial colonization in hemodialysis temporary dual lumen catheters: a prospective study. Ren Fail. 2008;30(1):31-5.
31. CAYLAN R. YG, SOZEN E.E., AYDIN K., KOKSAL I. Incidence and risk factors for bloodstream infections stemming from temporary hemodialysis catheters. Turk J Med Sci. 2010;40(6):835-41.
32. Weijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant. 2004;19(3):670-7.
33. Moretti EW, Ofstead CL, Kristy RM, Wetzler HP. Impact of central venous catheter type and methods on catheter-related colonization and bacteraemia. J Hosp Infect. 2005;61(2):139-45.
34. Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int. 2000;58(6):2543-5.
35. Grothe C, da Silva Belasco AG, de Cassia Bittencourt AR, Vianna LA, de Castro Cintra Sesso R, Barbosa DA. Incidence of bloodstream infection among patients on hemodialysis by central venous catheter. Rev Lat Am Enfermagem. 2010;18(1):73-80.
36. Gauna TT, Oshiro E, Luzio YC, Paniago AM, Pontes ER, Chang MR. Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil. Rev Soc Bras Med Trop. 2013;46(4):426-32.
37. Lai CF, Liao CH, Pai MF, Chu FY, Hsu SP, Chen HY, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2011;6(1):167-74.
38. Rodriguez-Aranda A, Alcazar JM, Sanz F, Garcia-Martin F, Otero JR, Aguado JM, et al. Endoluminal colonization as a risk factor for coagulase-negative staphylococcal catheter-related bloodstream infections in haemodialysis patients. Nephrol Dial Transplant. 2011;26(3):948-55.
39. Abdul Gafor AH, Cheong Ping P, Zainal Abidin AF, Saruddin MZ, Kah Yan N, Adam SQ, et al. Antibiogram for haemodialysis catheter-related bloodstream infections. Int J Nephrol. 2014; 629459.
40. Almuneef MA, Memish ZA, Balkhy HH, Hijazi O, Cunningham G, Francis C. Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect. 2006;62(2):207-13.
41. Braun E, Hussein K, Geffen Y, Rabino G, Bar-Lavie Y, Paul M. Predominance of Gram-negative bacilli among patients with catheter-related bloodstream infections. Clin Microbiol Infect. 2014;20(10):O627-9.
42. Murray EC, Marek A, Thomson PC, Coia JE. Gram-negative bacteraemia in haemodialysis. Nephrol Dial Transplant. 2015;30(7):1202-8.
43. Merino JL, Bouarich H, Pita MJ, Martinez P, Bueno B, Caldes S, et al. Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals. Nefrologia. 2016;36(6):667-73.
44. Kimura M, Kawai E, Yaoita H, Ichinoi N, Sakamoto O, Kure S. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia. Case Rep Infect Dis. 2017; 1254175.
45. Cunha BA, Theodoris AC, Yannelli B. Enterobacter cloacae graft infection/bacteremia in a hemodialysis patient. Am J Infect Control. 2000;28(2):181-3.
46. Kataria A, Lata S, Khillan V. Hemodialysis catheter-related bacteremia caused by Stenotrophomonas maltophilia. Indian J Nephrol. 2015;25(5):318-9.
47. Calfee DP. Multidrug-resistant organisms in dialysis patients. Semin Dial. 2013;26(4):447-56.
48. Snyder GM, D'Agata EM. Novel antimicrobial-resistant bacteria among patients requiring chronic hemodialysis. Curr Opin Nephrol Hypertens. 2012;21(2):211-5.
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