Vascular access-related infections are a significant cause of morbidity and mortality among patients on maintenance hemodialysis (MHD). In developing countries like Nigeria, the reliance on central venous catheters (CVCs) as a primary vascular access point increases the risk of catheter-related bloodstream infections (CRBSI). This report highlights the clinical management of CRBSI and the systemic constraints faced in resource-limited settings. The index case was a 49-year-old woman with end-stage renal disease (ESRD) secondary to diabetes mellitus, currently on MHD via a CVC, presented with a high-grade fever during a dialysis session. Clinical examination and positive blood cultures drawn from the dialysis tubing confirmed a CRBSI. No other focal source of infection was identified. Microbiological analysis identified the pathogen (consistent with common isolates like Staphylococcus aureus). The patient was managed with a combination of topical and parenteral antibiotics tailored to the microbiogram. Following initial stabilization and antibiotic therapy, a catheter exchange was performed to eliminate the source of the infection.The patient showed clinical improvement with the resolution of fever and clearance of the bloodstream infection. However, the management process was complicated by significant local constraints, including the inability to monitor serum trough levels for antibiotic dosing, the high cost of specialized medications, and the limited availability of drugs effective against methicillin-resistant S. aureus (MRSA). Catheter-related bloodstream infection remains a formidable complication for hemodialysis patients in Nigeria. While definitive treatment involving targeted antibiotics and catheter exchange is effective, there is an urgent need for improved access to affordable MRSA-active antibiotics and laboratory facilities for therapeutic drug monitoring to optimize patient outcomes.
Chimezie Okwuonu (Tue,) studied this question.