The burden and outcomes of hemodialysis catheter-related infections among hemodialysis patients at Muhimbili National Hospital for the past two years.

Abstract

ABSTRACT Background: Given the increasing burden of kidney diseases, hemodialysis as the primary method of renal replacement therapy is a lifesaver, elongates the survival of patients, reduces morbidity, and improves the quality of life. Increased need for hemodialysis among patients with End Stage Renal Disease (ESRD), and Hemodialysis (HD) catheter-related infections have shown a significant role in hospitalizations, morbidity, and death and raise significant concerns about the costs of treatments or premature removal and replacements of HD catheters. Approximately 50% of hemodialysis catheters fail within 1 year and many patients die within 6 months of the initiation of Hemodialysis (HD), which may be related to, among others, vascular-access-related complications (1) Aim of the study: The study aimed to assess the Burden and outcomes of Hemodialysis Catheter-related infections among hemodialysis patients who received maintenance HD services at Muhimbili National Hospital for the past two years. Methodology: A Retrospective Cohort single-center hospital-based study with a quantitative approach involving 360 end-stage renal disease participants, aged above 18 years was conducted at Muhimbili National Hospital to determine the Prevalence and outcomes of hemodialysis catheter infections among hemodialysis patients who received maintenance HD services from January 2022 to December 2023. Kaplan-Meir & log-rank tests were used to evaluate the effect of infection on survival by type of catheter. The prevalence of HD-Catheter infections was presented in % and 95% Confidence intervals. Cox regression analysis was used to estimate the effect of the various factors on the outcomes of the HD catheter-related infection. Mann Whitney U test was used to compare the effect of the CVC and TCC on the CRIs. Results: 360 hemodialysis participants with a mean age of 53 ± 14 years participated in the study. The prevalence of HD catheter-related infection was found to be 51.1%, 56.4%, and 80.8% mainly based on the cause of Fever, Blood/Pus cultures results, and Types of Vascular access respectively. 51.4% of the patients suffered from both Hypertension and Diabetes Mellitus as the main underlying illness for ESRD, and 80.8% used a Central Venous Catheter while only 19.2% had Tunneled Central Venous Catheters. Outcomes of the CRIs were mortality (9.8%), Re-catheterization (75%), Readmissions (12%), and ICU admissions (17.9%). Mann Whitney U test showed that CVC had a slightly higher effect (33344) on a Catheter-related infection than TCC (SumR-31636) although it was not statistically significant (p-0.89). Also, the Kaplan-Meir test found no significant difference in effect between CVC and TCC on Catheter-related infections hence the curves (CVC & TCC) were parallel regarding the time of Catheter device in the body (p >0.05). Conclusion: The study found that infections are common complications in individuals with end-stage renal disease (ESRD) undergoing long-term hemodialysis with the Prevalence of Catheter-Related Bloodstream Infections (CRBSI) based on fever cause (51.1%), Blood/ Pus Culture (Bacteria growth) results (56.4%), and type of vascular access (80.8%). Among the participants population, males were the most frequently affected gender. Several clinical outcomes were associated with HD catheter-related infections, including admissions to Intensive Care Units (ICUs), a high rate of re-catheterization, hospital readmissions due to sepsis-related to hemodialysis catheters, mortality rates, and the duration of catheter placement in hemodialysis patients, which ranged from 30 to 90 days. The only factors that demonstrated a significant impact both positively and negatively on mortality and ICU admissions for participants with HD catheter-related infections were vocational training and adherence to treatment protocols. Additionally, being retired emerged as a positive predictor for the likelihood of re-catheterization among these participants. Recommendation Prospective longitudinal studies with a high sample size should be conducted in Tanzanian Hemodialysis Centers to determine the true prevalence, incidence, complications, and outcomes of HD catheter-related infections among hemodialysis patients. Improvement in the proper documentation of the patient’s diagnosis through a combination of observed symptoms, clinical signs, and quantitative culture methods and early diagnosis of CRBSI can help prevent complications and fatalities associated with the infection as most of the important variables were not included thus leading to insufficient information and loss of records. Infections can be reduced and entirely prevented by implementing stringent hygiene protocols, ensuring that all healthcare personnel receive proper training, providing high-quality individual patient care Utilizing sterile barrier precautions, and maintaining skin asepsis to minimize contamination from normal flora. Additionally, it is widely accepted that routinely changing catheters helps lower levels of colonization. While it's reasonable to use IV antibiotics in these patients, most causes of the infections were not ruled out as most of the blood culture was negative caused by early initiation of antibiotic therapies before culture growth was done. Therefore, initial antibiotic therapy should only be given after sample collection and results are available to be able to target the appropriate species of the bacteria. We strongly recommend that, blood cultures should be taken promptly from all participants suspected to have bacteremia associated with central venous catheterization.