Dialysis catheter-associated bloodstream infections (DCBIs) cause significant morbidity and mortality in end stage renal disease (ESRD) patients. The epidemiology of DCBI has not been described in patients receiving hemodialysis on an emergent basis. We investigated the epidemiology of DCBI in our institution’s emergent hemodialysis cohort.
We performed a retrospective chart review of all ESRD patients who received hemodialysis solely on an emergent basis at Ben Taub General Hospital in Houston, TX between 1/1/2012 and 12/31/2015. We recorded patient demographics, comorbidities, and all DCBIs that occurred during the study period. We defined DCBI as a positive blood or catheter tip culture identified and treated as a catheter-associated infection by the treatment team.
Of the total 342 ESRD patients, 78 patients had 120 DCBIs; 23 had multiple DCBIs and there were 17 recurrent infections (recurrence rate 16.5%). Patients with DCBIs had a longer duration of hemodialysis (20.5 vs 15.1 months, p=0.0012) and received more frequent dialysis (5.9 vs 5.15 sessions/month, p = 0.0011).
5.1% of patients died during a DCBI; the per-episode mortality rate was 3.3%. Gram-positive organisms were isolated in 57.5% of cases (14.9% were MRSA and 13.4% CONS). Gram-negative organisms were isolated in 41.8%, with Pseudomonas in 3.7% of cases. 10.8% of DCBIs were polymicrobial.
The mean duration between episodes of infection was 149.6 days. 70.6% of recurrent infections were due to gram-positive organisms. Staphylococcus aureus (30% MRSA) caused recurrent infection most frequently, occurring in 58.8% of cases. Only MSSA was statistically associated with recurrent infection (RR 2.14; 95% CI 1.01-4.51, p=0.046). Among the recurrent gram-negative infections, Enterobacter cloacae was most common.
DCBI in the emergent hemodialysis patient population is associated with the total duration and frequency of hemodialysis. Initial infection with MSSA predicted recurrent infection. Gram-negative infections occurred more frequently than has been described in catheter infections in patients receiving scheduled hemodialysis.
M. Shah, None
E. Wu, None
R. Zamani, None
D. Chen, None
S. Mandayam, None