Prevalence, Bacterial Spectrum and Risk Factors for Catheter-Related Bloodstream Infections (CRBSI) in Patients on Maintenance Hemodialysis in a Tertiary Care Hospital

Background: Catheter-Related Bloodstream Infections (CRBSI) represent a serious complication in patients undergoing maintenance hemodialysis through central venous catheters. Indian data on CRBSI prevalence, causative organisms and contributory risk factors remain limited. This study aimed to determine the prevalence, bacteriological spectrum, antimicrobial susceptibility patterns and associated risk factors for CRBSI among hemodialysis patients at a tertiary care centre. Methods: A prospective observational study was conducted over one year (October 2021 to September 2022) in a tertiary care teaching hospital. Paired blood cultures from the catheter hub and peripheral vein were obtained from 288 chronic kidney disease patients on maintenance hemodialysis with central venous catheters in situ for 48 hours or longer, who were clinically suspected of CRBSI. Diagnosis was established using the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) 2006 criteria. Antimicrobial susceptibility was determined by the Kirby-Bauer disc diffusion method following Clinical and Laboratory Standards Institute guidelines. Results: The overall CRBSI prevalence was 11.80% (34/288), with a definite CRBSI rate of 1.11 per 1000 catheter days. Gram-negative bacilli predominated (51.26%), with Klebsiella pneumoniae being the commonest isolate in definite cases. Hypertension (p = 0.001), co-existing diabetes mellitus with hypertension (p = 0.009) and tunnelled catheter use (p < 0.001) were significant risk factors. All Gram-positive isolates were susceptible to vancomycin, teicoplanin and linezolid. The mortality rate was 11.76%. Conclusion: CRBSI remains a notable complication in hemodialysis patients in our setting. Gram-negative bacilli constitute the predominant pathogens. Routine surveillance blood cultures and institution-specific antimicrobial stewardship are essential to guide empirical therapy and reduce adverse outcomes.