CLINICO-MICROBIOLOGICAL SPECTRUM OF HEMODIALYSIS CATHETER-RELATED BLOOD STREAM INFECTIONS: A CONCISE REVIEW

The disease burden of chronic kidney disease is increasing worldwide, and with the growing population of patients requiring hemodialysis, more patients are placed on central venous catheters (CVCs). Vascular access infections significantly cause hospitalization and mortality among end-stage renal disease (ESRD) patients. As per the data from the United States, Gram-positive organisms account for almost 56% of the total cases of catheter-related bloodstream infection (CRBSI), in stark contrast to Indian studies showing a dominance of Gram-negative organisms. The prolonged use of non-tunnelled catheters, poor hygiene, lack of catheter care protocols, and the tropical climate pose unique challenges to control CRBSIs in resource-poor countries. The most effective strategy to prevent CRBSI is to minimize the duration of dialysis catheters. Other strategies include the introduction of strict catheter care protocols, using tunnelled cuffed catheters, anti-microbial lock solutions, and topical antimicrobials. Eradicating nasal carriage of Staphylococcus aureus also reduced the incidence of CRBSIs.Treatment of suspected CRBSI should be promptly initiated with empirical broad-spectrum antibiotics covering Gram-positive and Gram-negative organisms. Catheter removal is indicated only if the patient is clinically unstable, has metastatic infections, and those who do not respond to antibiotic therapy.