Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters

BACKGROUND: Infection is the most frequent complication of central venous catheters used for hemodialysis. OBJECTIVES: The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections. METHODS: This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center. RESULTS: 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures. CONCLUSION: The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.