Prevalence and microbiologic profile of catheter-related bloodstream infections in chronic kidney disease patients in Baguio General Hospital and Medical Center

Introduction: Central venous catheters (CVCs) are utilized as access for hemodialysis (HD) in emergency settings in Baguio General Hospital and Medical Center (BGHMC). CVCs remain the primary vascular access of chronic kidney disease (CKD) patients undergoing hemodialysis until there is available chronic HD access.

Methods: Cross-sectional study and random sampling were performed by reviewing medical charts, hemodialysis unit data, and microbiological laboratory records. The study population included adult patients diagnosed with CKD requiring HD, who had been inserted with CVC and underwent hemodialysis in BGHMC from January 1, 2022 to December 31, 2024. A sample size of at least 329 subjects was needed to achieve 95% significance level using OpenEpi and was modified based on an expected occurrence rate of 31% for catheter-related bloodstream infections (CRBSI) in hemodialysis patients.

Results: Prevalence of CRBSI was documented at 12.67 episodes per 1000 CVC days with median duration of CVC placement from insertion to infection at 58 days. Among gram negative isolates (n = 28, 70%), Pseudomonas aeruginosa (n = 6, 15%) was the most common causative organism followed by Extended-Spectrum-Beta-Lactamase-producing Klebsiella pneumoniae (n = 4, 10%), Stenotrophomonas maltophilia (n = 3, 7.5%), Acinetobacter baumannii (n = 3, 7.5%), Burkholderia cepacia (n = 2, 5%) and Sphingomonas paucimobilis (n = 2, 5%). Among Gram positive isolates (n= 12, 30%), Staphylococcus aureus (n=5, 12.5%) was the most common organism followed by Methicillin Resistant Staphylococcus epidermidis (n = 4, 10%), Methicillin Resistant Staphylococcus aureus (n = 2, 5%) and Staphylococcus haemolyticus (n = 1, 2.5%).

Conclusion: The noted increased prevalence of CRBSI could be attributed to prolonged catheter days. The increasing prevalence calls for re-evaluation of practices involving CVC and strict adherence to recommendation that for patients undergoing maintenance hemodialysis, CVC should be switched to chronic HD access like arteriovenous fistula (AVF) or arteriovenous graft (AVG) as early as possible.

Keywords: Chronic kidney disease, hemodialysis, central venous catheters, nosocomial infections, catheter-related bloodstream infections.