Risk factors of the early onset of catheter-related bloodstream infection among hemodialysis patients admitted at a tertiary hospital: A 5-year retrospective analysis (2018–2022)

Title : Risk factors of the early onset of catheter-related bloodstream infection among hemodialysis patients admitted at a tertiary hospital: A 5-year retrospective analysis (2018–2022)

Abstract:

Introduction: Catheter-related bloodstream infection (CRBSI) remains a major cause of morbidity and mortality among hemodialysis (HD) patients worldwide. In low- and middle-income settings, limited vascular-access options and prolonged catheter use heighten infection risk. Local data on risk factors and microbial resistance are scarce.

Methods: A five-year retrospective case-control study was conducted among 200 adult HD patients admitted to a tertiary hospital (2018–2022): 100 with CRBSI and 100 without. Clinicodemographic, treatment, and microbiologic variables were collected. Univariate tests and multivariate logistic regression identified independent predictors of CRBSI. Pathogen distribution and antimicrobial susceptibility were analyzed using standard microbiologic protocols.

Results: Patients with CRBSI had significantly longer ICU stays (6.6 ± 3.4 vs 2.1 ± 1.4 days; p < 0.001) and higher APACHE scores (20.4 ± 5.4 vs 11.6 ± 4.0; p < 0.001). Broad-spectrum antibiotic exposure (meropenem, piperacillin-tazobactam, vancomycin) was associated with infection (all p < 0.01). Predominant isolates were coagulase-negative Staphylococci (19 %), S. aureus (18 %), Klebsiella (14 %), Pseudomonas aeruginosa (11 %), Enterococcus (17 %), E. coli (9 %), Candida (7 %), and Acinetobacter (5 %). β-lactam resistance was frequent among gram-negative species. Independent predictors of CRBSI included prolonged ICU stay (OR 0.42, 95 % CI 0.27–0.63; p < 0.001), higher APACHE score (OR 0.68, 95 % CI 0.58–0.80; p < 0.001), and broad-spectrum antibiotic use (p < 0.01). Model accuracy = 93.5 %, AUC = 0.98.

Conclusion: Prolonged ICU stay, greater illness severity, and extensive antimicrobial exposure significantly predict early-onset CRBSI in HD patients. The predominance of resistant gram-positive and gram-negative organisms underscores the urgent need for targeted infection-control programs and antimicrobial-stewardship initiatives in dialysis units, particularly within resource-limited regions.

Keywords: Catheter-related bloodstream infection; hemodialysis; antimicrobial resistance; risk factors; ICU stay.

Biography:

Devin Edjohn Michael A. Aballe, MD, RN is a Filipino physician currently completing his Internal Medicine residency at Vicente Sotto Memorial Medical Center, where he also serves as Assistant Chief Resident. He earned his Doctor of Medicine degree from Cebu Institute of Medicine and graduated with Gold Medal honors in Nursing from Cebu Doctors’ University, placing Top 5 in the Philippine Nursing Licensure Examination. His clinical and research interests focus on infectious diseases, nephrology, and antimicrobial stewardship. He has presented research on catheter-related bloodstream infections among hemodialysis patients and remains committed to improving patient outcomes in resource-limited settings.