Incidence, microbiological aspects and associated risk factors of catheter-related bloodstream infections in adults on chronic haemodialysis at a tertiary hospital in Uganda.
Doreen Nanyunja, Mogamat-Yazied Chothia, Kenneth C Opio, Ponsiano Ocama, Freddie Bwanga, Daniel Kiggundu, Pauline Byakika-Kibwika
Author Information
Doreen Nanyunja: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Mogamat-Yazied Chothia: Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Kenneth C Opio: Aga Khan University Hospital, Nairobi, Kenya.
Ponsiano Ocama: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Freddie Bwanga: Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.
Daniel Kiggundu: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Pauline Byakika-Kibwika: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Objectives: The high burden of infectious complications among patients receiving haemodialysis (HD) via central venous catheters increases morbidity and mortality. This study determined the incidence of catheter-related bloodstream infections (CRBSIs), microbiological profile of causative organisms, and associated predictors in patients on chronic HD. Methods: A prospective single-centre cohort study of 121 adult patients with end-stage kidney disease was conducted from October 2019 to March 2020. Antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method. Cox proportional hazards model was used to determine predictors of CRBSI. Results: The mean age was 50 (standard deviation 14.9) years and the median duration of follow-up was 69 (interquartile range 23-124) days. At least one CRBSI was recorded for 41% of patients, at a rate of 5.2 infections per 1000 patient-days. Causative organisms were predominantly Gram-negative bacteria (60.3%), and 36.5% of all isolates were multi-drug resistant. Anaemia [hazard ratio (HR) 5.44, 0.019, 95% confidence interval (CI) 1.32-22.48] and previous bloodstream infection [HR 2.47, 0.028, 95% CI 1.10-5.54] were predictors of CRBSI. Conclusion: The high incidence of CRBSI in patients on chronic HD with predominance of Gram-negative bacteria means that catheter care bundles should include Gram-negative coverage.
