CATHETER RELATED BLOODSTREAM INFECTION RATE AT THE FIJI NATIONAL KIDNEY CENTRE
Dr Abhitesh Raj1, Dr Anis Ta’eed1
1Ministry Of Health And Medical Services, , Fiji
Aim: To Identify the rate of catheter-related bloodstream infections (CRBSI) at the Fiji National Kidney Centre (FNKC).
Background: FNKC is the largest public chronic haemodialysis unit in Fiji. Due to limited access to AV fistula creation, almost all patients use tunnelled catheters. The Fiji Dialysis Registry has highlighted infection as a major source of morbidity and mortality in patients undergoing chronic haemodialysis in Fiji.
Methods: All patients who received chronic haemodialysis exclusively at FNKC between 18/03/21 to 18/03/24 with a new tunnelled catheter were included. Patient demographics, clinical outcomes and details regarding tunnelled catheter insertion and removal were retrospectively collected from medical records and analysed. CRBSI was defined as a positive blood culture in the absence of another infection source.
Results: During the 3-year period, 73 tunnelled catheters (86.3% internal jugular, 13.7% femoral) in 45 patients (mean age 47.5 ± 13.6 years, male 75.6%, diabetes 60%) were managed at FNKC. Median catheter life was 159 days (IQR 58, 350). Reasons for catheter discontinuation were infection (32.9%), patient death (26%), mechanical (12.3%) and AVF creation (1.4%), with 20 catheters (27.4%) still functioning without CRBSI at the end of the study. During 15125 catheter days 24 episodes of CRBSI occurred in 15 patients, with a rate of 1.79 CRBSI per 1000 catheter days. Of the 27 organisms cultured, 12 (44%) were multi-drug resistant and 4 (14.8%) were fungal. Four patients (8.9%) died from CRBSI.
Conclusions: The CRBSI rate at FNKC is over 5 times higher than our neighbour Australia. These results will serve as a baseline for future quality improvement initiatives to reduce CRBSI rates and to advocate for improved access to AVF creation in Fiji.
Biography:
Dr. Abhitesh Raj is a Masters of Medicine: Internal Medicine graduate from the Fiji National University with over 3 years experience working as a nephrologist at the Colonial War Memorial Hospital, Suva, Fiji. He is an executive committee member of the Nephrology Society of Fiji with interests in interventional nephrology and glomerulonephritis and passionate about improving standards of healthcare in Fiji.