“Clinical and Microbiological Evaluation of Bloodstream Infections in Patients Undergoing Maintenance Hemodialysis: A Study in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh”

Abstract

Introduction: Chronic kidney disease (CKD) is one of the most common non communicable diseases throughout the world. According to the data of Bangladesh Renal Registry almost twenty millions of Bangladeshi adults are suffering from various stages of CKD. Many of these CKD patients ultimately developed ESRD when life is not sustainable unless renal replacement therapy is initiated. Objective: The purpose of the present study was to estimate the rates of infections and clinical and microbiological evaluation of bloodstream infections in patients undergoing maintenance hemodialysis. Methods: This cross sectional study was conducted from January 2014 to December 2015 for a period of 2(two) years in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University, Dhaka. All adult patients underwent hemodialysis of both sexes fulfilling the inclusion and exclusion criteria were included in the study. Then each patient was evaluated during each hemodialysis session for the (1) presence of bloodstream infection (BSI) using CDC (Centre for disease control) case definitions by blood cultures (Two samples were sent for cultures one from peripheral veins and another from vascular access either from fistula or from central venous catheter) and (2) clinical features. Result: The mean age of the patients were 38.26 (15.26) years. In this present study male (71.7%) are predominant than female (28.3%). Maximum (51.7%) patients were under weight. In this study 50 (83.3%) patients had anemia. Mean (SD) WBC, Hb, S. uric acid, FPG, Plasma glucose 2h ABF, HbA1C, S. total protein and S. albumin were 14415 (4000) count/cmm, 9.61 (1.62) g/dl, 417.67 (100.87) µmol/l, 5.37 (1.18) mmol/l, 7.27 (2.18) mmol/l, 6.42 % (0.68), 62.71 (5.82) g/l and 28.97 (4.99) g/l respectively. Out of 46 AV fistula cases, culture was positive in vein 8 (13.3%) cases and in fistula 5 (10.8%) cases. Out of 11 permanent CV catheter cases, culture was positive in vein 6 (54.5%) cases and in catheter 7 (63.3%) cases. Out of 3 catheter tip cases, culture was positive in catheter tip 2 (66.7%) cases. Among 28 bacteremic episodes Pseudomonas aeruginosa were 53.57%, Acinetobacter spp. were 35.71% and Klebsiella spp. were 10.71%. Blood stream infection rate due to hemodialysis in fistula was 0.24/1000 patient-days, in catheter was 3.05/1000 patient-days and total was 1.19/1000 patient-days. Acinetobacter spp (6.7%) and Pseudomonas aeruginosa (16.7%) were found in peripheral vein. Acinetobacter spp in 3(6.5%) and Pseudomonas aeruginosa were present in 2(4.3%) cases in AV fistula. Klebsiella spp. were present in 3 (21.4%) cases, Acinetobacter spp were in 3 (21.4%) cases and Pseudomonas aeruginosa were in 3(21.4%) cases in Central venous catheter. Conclusion: The risk of BSI in patients undergoing hemodialysis is related to the vascular access (tunneled central venous catheter), low haemoglobin, underweight, low serum total protein and low serum albumin.