Publication:

Clinical and microbiological spectrum of catheter-related bloodstream infections in non-tunneled and tunneled internal jugular vein hemodialysis catheters at a tertiary care hospital in Uttarakhand

Background Catheter-related bloodstream infection (CRBSI) is a significant cause of morbidity and mortality in patients undergoing hemodialysis. In this prospective cohort study, we studied the incidence rate of CRBSI as well as the clinical and microbiological profile in non-tunneled and tunneled hemodialysis catheters.

Methods Patients were recruited as per inclusion/exclusion criteria. Patients with non-tunneled internal jugular catheters were followed for 1 month and tunneled internal jugular were followed for 3 months. Patients with clinical signs and symptoms suggestive of CRBSI were admitted. We followed the centers for disease control and prevention (CDC) guidelines for the diagnosis of catheter-associated bloodstream infections microbiological methods-blood samples were inoculated on an automated BACTEC system for 5 days. If microbial growth was detected by the automated system, Gram staining was performed and growth was sub-cultured on culture media.

Results The 202 patients underwent internal jugular vein hemodialysis catheter insertion. The 21 patients were excluded from the study. Total 181 patients were confirmed eligible. The 16.0% of the participants (29 patients) developed CRBSI during follow up. Incidence of CRBSI in our study was 3.73 episodes per 1000 catheter days. Diabetes mellitus and low BMI were risk factors for CRBSI. Most of the CRBSI were caused by gram negative organism. Overall, 65.5% of CRBSI were caused by multidrug resistant organisms.

Conclusions Incidence of CRBSI was high in non-tunneled catheters as compared to tunneled catheters.