SP570DEVELOPMENT, IMPLEMENTATION AND FOLLOW UP OF HEMODIALYSIS CATHETER RELATED BLOOD STREAM INFECTION (CRBSI) MANAGEMENT PROTOCOL, A SINGLE CENTER EXPERIENCE

Abstract

Introduction and Aims: Intravascular hemodialysis catheters play a central role in management of patients with renal impairment. Catheter related blood stream infection (CRBSI) is one of the major complications of intravascular catheters. CRBSI is associated with increased morbidity, mortality and health care cost. The objective of our work was to develop a management protocol for proper diagnosis and treatment of such condition. Methods: We reviewed healthcare records for all CRBSI cases in our center in 2014, the diagnosis and management protocol that was implemented by our staff. We subsequently revised results of all blood cultures drawn for suspected CRBSI in 2014 to identify most common isolated organisms and their susceptibility profile. We then reviewed all major guidelines discussing CRBSI prevention, diagnosis and management in the literature. We developed CRBSI management protocol, taking into consideration our own collected data, with the cooperation of nephrology, microbiology, clinical pharmacy and quality improvement department. Finally, we compared data of CRBSI management and patients' outcomes before (2014) and after (2015) protocol implementation. Results: We developed a protocol for proper management of CRBSI cases (Figure 1). Comparison of data between 2014 (before protocol implementation) & 2015 (after protocol implementation) is tabulated in table1. Clinical and laboratory improvement after protocol implementation: Symptoms started to improve mostly within 48 hours of treatment. Fever disappeared completely on the 3rd day in 90% of the cases. Mean WBCs decreased from 20.5 x 109/L (on the day on admission) to 12.2 x 109/L (after 48 hours) to 9.96 x 109/L (after 96 hours). Mean C - Reactive Protein (CRP) decreased from 123.5 mg/L (on the day of diagnosis) to 86.16 mg/L (after 48 hours) to 52.6 mg/L (after 96 hours). Mean hospital stay/ episode of CRBSI decreased from 15.6 days/ episode (in 2014) to 7.3 days/episode (in 2015). Only one case died during hospitalization due to associated multi-organ failure. Conclusions: Adopting and adapting international guidelines per local data is useful for both patient and disease related outcomes. A local protocol is, therefore, needed for proper prevention, management and follow up of patients with CRBSI. Results of blood cultures have to be reviewed periodically to have a comprehensive idea about causative organisms and their antibiogram. Implementation and follow up of such a condition with subsequent modification will help to supply good care for these patients and will surely decrease morbidity and mortality of such condition. (Figure Presented).