A six-year experience of catheter-related bloodstream infections in hemodialysis patients

Abstract

Introduction: This study investigated the clinical characteristics, causative microorganisms, and antibiotic resistance patterns of catheter-related bloodstream infections (CRBSIs) in hemodialysis patients at a tertiary healthcare institution.

Methodology: A retrospective analysis of 300 patients treated for CRBSIs between January 2018 and December 2023 was conducted. Patients were divided into two groups: those with less than 1 year of hemodialysis (Group 1) and those with more than 1 year of hemodialysis (Group 2). Risk factors for intensive care unit (ICU) transfer and 28-day mortality were analyzed.

Results: The median age was 68 years. Gram-positive bacteria were the predominant pathogens (69%), with Staphylococcus aureus being the most frequent. Group 1 had significantly higher rates of recent hospitalization (p = 0.014) and a history of previous ICU admission (p = 0.001). However, no significant differences were found in causative microorganisms or antimicrobial resistance between the two groups. Risk factors for ICU transfer included carbapenem resistance (OR: 7.657, p = 0.013), history of catheter revision (OR: 4.632, p = 0.022), and leukocytosis (OR: 1.150, p = 0.004). The 28-day mortality rate was 8%. Significant risk factors for mortality were ICU transfer (OR: 17.29; p = 0.001) and Vancomycin-Resistant Enterococcus (VRE) infection (OR: 14.10; p = 0.002).

Conclusions: Despite shorter-term dialysis patients having more frequent hospitalizations, the distribution and resistance of pathogens remain similar regardless of hemodialysis duration. Empirical therapy should prioritize broad anti-staphylococcal coverage and be tailored to specific risk factors such as VRE or carbapenem resistance rather than hemodialysis duration.