Catheter Related Blood Stream Infection in patients undergoing Hemodialysis in a tertiary care centre

BackgroundCatheter-related bloodstream infection (CRBSI) is a major cause of morbidity and mortality among patients undergoing hemodialysis (HD), particularly in low- and middle-income settings where non-tunneled hemodialysis catheters (NTHC) are widely used. Local epidemiological data are essential to guide preventive and therapeutic strategies. ObjectivesTo determine the prevalence, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CRBSI in patients undergoing HD via internal jugular NTHC at a tertiary care center in South India. MethodsThis retrospective observational study included adults initiated on HD using internal jugular NTHC between January 2017 and December 2023. Patients with pre-existing infections or catheters inserted elsewhere were excluded. CRBSI was defined using KDOQI criteria. Demographic, clinical, laboratory, microbiological, and outcome data were analyzed. Logistic regression identified risk factors, and receiver operating characteristic (ROC) analysis evaluated predictors of adverse outcomes. ResultsAmong 396 patients (mean age 56.3 {+/-} 14 years; 70.4% male), 65 (16.4%) developed CRBSI, with an incidence of 4.7 per 1000 catheter days. Emergency HD initiation (OR 14.86, p < 0.001) and access failure (OR 2.71, p = 0.004) significantly increased CRBSI risk, while planned initiation for uremic symptoms was protective. Patients with CRBSI had lower serum albumin and higher leukocyte counts. Gram-negative organisms predominated (53.8%), with Klebsiella pneumoniae being the most common isolate. High resistance was observed to {beta}-lactam/{beta}-lactamase inhibitor combinations and carbapenems. Gram-negative CRBSI was associated with significantly higher odds of hospitalization, ICU admission, inotropic support, and mortality. ROC analysis showed good predictive ability for adverse outcomes (AUC 0.73-0.77). ConclusionsCRBSI remains a significant complication of NTHC-based HD. Predominant Gram-negative infections with high antimicrobial resistance are associated with worse clinical outcomes, underscoring the need for early permanent access creation, strict catheter care, and robust antibiotic stewardship.