Factors Involved in Cuffed Catheter-Related Infections in Hemodialysis Patients

Background and Aims: Dialysis catheter-related infections (CRI) remain a significant cause for morbidity and mortality in hemodialysis patients. We studied factors that predispose hemodialysis patients to CRI.

Methods: This a retrospective case controlled study of hemodialysis patients with a cuffed permanent catheter access conducted over a 12-month period. Those developing CRI acted as the study group and those who remained free of CRI acted as controls.

Patients and catheter variables that were documented included: Chronic Comorbidity Index (CCI), serum albumin level, Kt/V, number of CRI, organism/s isolated, and whether the catheter had to be removed. Significance of differences between the two groups was assessed using two tailed independent test for continuous variables and Chi square for categorical variables.

Results: Fifty-seven study patients and 39 controls were included. There were 107 episodes CRIs. The number of episodes of infection/catheter patients was 1.1 after a mean follow up period of 933 (± 255) days. Number of episodes of infection per 1000 catheter/days was 1.2 and per 100 dialysis sessions was 0.714.

Catheter duration was shorter (1040 ± 198 days) in the infected group compared to the control group (1139 ± 275 days, p=0.042). The commonest organism isolated was Staph aureus (35%) followed by Enterobacter cloacae (14.8%). The commonest antibiotic used was vancomycin, followed by gentamycin and ceftazidime. The actuarial catheter survival was markedly less with multiple episodes of infection compared to single episode (p=0.029). A single episode of infection was associated with 9.5% chance of catheter losses as opposed to a 43.3% chance in multiple infections (p=0.0001).

Conclusions: Risk of infection was increased with femoral placement and number of dialysis sessions. The risk of catheter loss with multiple infections is more. The demographic characteristics are not a risk factor for developing infection.