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"The high incidence of CRBSI in patients on chronic HD with predominance of Gram-negative bacteria means that catheter care bundles should include Gram-negative coverage" Nanyunja et al (2022).
CLABSI in haemodialysis patients

Abstract:

Objectives: The high burden of infectious complications among patients receiving haemodialysis (HD) via central venous catheters increases morbidity and mortality. This study determined the incidence of catheter-related bloodstream infections (CRBSIs), microbiological profile of causative organisms, and associated predictors in patients on chronic HD.

Methods: A prospective single-centre cohort study of 121 adult patients with end-stage kidney disease was conducted from October 2019 to March 2020. Antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method. Cox proportional hazards model was used to determine predictors of CRBSI.

Results: The mean age was 50 (standard deviation 14.9) years and the median duration of follow-up was 69 (interquartile range 23-124) days. At least one CRBSI was recorded for 41% of patients, at a rate of 5.2 infections per 1000 patient-days. Causative organisms were predominantly Gram-negative bacteria (60.3%), and 36.5% of all isolates were multi-drug resistant. Anaemia [hazard ratio (HR) 5.44, P=0.019, 95% confidence interval (CI) 1.32-22.48] and previous bloodstream infection [HR 2.47, P=0.028, 95% CI 1.10-5.54] were predictors of CRBSI.

Conclusion: The high incidence of CRBSI in patients on chronic HD with predominance of Gram-negative bacteria means that catheter care bundles should include Gram-negative coverage.

Reference:

Nanyunja D, Chothia MY, Opio KC, Ocama P, Bwanga F, Kiggundu D, Byakika-Kibwika P. Incidence, microbiological aspects and associated risk factors of catheter-related bloodstream infections in adults on chronic haemodialysis at a tertiary hospital in Uganda. IJID Reg. 2022 Sep 14;5:72-78. doi: 10.1016/j.ijregi.2022.09.002. PMID: 36212918; PMCID: PMC9535435.

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