Department of Internal Medicine - Bicol Regional Training and Teaching Hospital - Department of Health
August 1, 2016-March 1, 2017
Intravascular device-related bacteremia cause approximately 10-15% of nosocomial infections, most of which are from central vascular catheters (CVCs). Eighty-one (81) temporary hemodialysis catheters among sixty-six (66) patients were evaluated over a six (6) month study period in the BRTTH Hemodialysis Facility. The patients' clinical profile, i.e. age; sex; causes of ESRD; signs and symptoms, and risk factors of probable temporary vascular catheter infection; and temporary vascular catheter insertion technique were studied. Descriptive analysis was carried out. The incidence of CRBSI was 2.5/1,000 patient-days or 2.48/1000 catheter days. The predominant organism isolated among the definite CRB were Pseudomonas aeruginosa (40%), Staphylococcus epidermidis (20%), Staphylococcus aureus (20%), and Staphylococcus hemolyticus (20%). The causes of ESRD in descending order were hypertensive nephrosclerosis (39.39%), diabetic kidney disease (25.75%), chronic glomerulonephritis (22.73%), gouty nephropathy (7.58%), polycystic kidney disease (3.03%) and obstructive uropathy (1.52%). Significant factors with positive correlation to CRBSI include age (X2(1) = .018, p <.05), sex (X2(1) = .011, p <.05), presence of diabetes (X2(1) = .015, p <.05), and length of time on dialysis or patient days (X2(1) = 0.039, p <.05). Clinically, there was a relationship between CRBSI and frequency of catheter insertion. Since forty percent (40%) of the isolated organism was Pseudomonas aeruginosa., it would be prudent to include an anti-pseudomonal antibiotic for in-house empiric management. Recommendation should be based on hospital antibiogram. Though the rate of patients shifted to AVF HD access was higher compared to other studies, early AVF creation still proves to be a challenge in this center. Future studies might be considered focusing on resources critical for tracking and preventing infections and for evaluating the effectiveness of a specific infection prevention effort from the healthcare providers.
1. Morena, Lemaire X. Analysis of Risk Factors for Catheter-Related Bacteremia in 2000 Permanent Dual Catheters for Hemodialysis. 2000.