Abstract

Central venous catheter-related blood stream infection (CRBSI) is a major cause of morbidity and mortality in patients on maintenance hemodialysis. The objective of the study was to assess the microbiology and clinical outcomes of CRBSI in patients on maintenance hemodialysis. This was a retrospective observational study of all the patients with Stage 5 chronic kidney disease on maintenance hemodialysis at Pushpagiri Medical College Hospital who developed CRBSI between 1st January 2019 and 31st December 2020. Out of the 105 CRBSI patients included in the study, 75% had diabetes mellitus while 95% had hypertension. The median time gap between central venous catheter (CVC) placement and CRBSI was found to be 22 days with a range of 3 days to 150 days. Fever was the most common clinical presentation of CRBSI while a few patients presented with encephalopathy and septic shock. The most commonly used empirical antibiotic was intravenous Cephalosporins. The most common micro-organism grown in culture was non-fermenting gram-negative rods (22.84%) followed by Staphylococcus aureus and Bacillus species. The success rate which was defined as resolution of symptoms without the need of modifying the antibiotic or change of CVC was 34.28%. 31% of patients required modification of antibiotic while 56.18% required change of CVC. Complications developed in 10.47% of patients, the most common being encephalopathy followed by septic shock. 5(4.7%) patients succumbed to complications while all others recovered completely. While treatment of CRBSI with empirical intravenous antibiotics alone was successful in only about one-third of the patients, culture-guided modification of antibiotic regimen with or without change of CVC, led to clinical improvement in the majority of cases.

Key words: Antibiotic, Central venous catheter-related blood stream infection, Chronic kidney disease, Hemodialysis