Background
Tunnelled haemodialysis (HD) catheters are still used extensively to access the blood-stream in both incident and prevalent HD patients. HD catheter related blood stream infections (HD-CRBSIs) are one of the most dreaded complications of tunnelled HD catheters due to the significant morbidity and mortality associated with such infections. This study is aimed to evaluate the characteristics and outcomes of patients who had tunnelled HD-CRBSIs in the Waikato Renal Unit.
Methods
This is a retrospective study of all tunnelled HD-CRBSIs presenting to Waikato Hospital between 1 January 2020 and 30 June 2024. We collected data on ethnicity, age, sex, locality, cause of ESKD, place of catheter insertion, diabetes status, catheter vintage and site, microbiological culture results and patient outcomes including death.
Results
In the 4.5-year period under study, there were 120 tunnelled HD-CRBSIs. Patient characteristics included: indigenous New Zealand Māori (74.1%), male gender (72.5%), average age (55 years), history of diabetes (60%), average catheter vintage (8 months). The predominant microorganisms isolated were gram-positive organisms: staphylococcus aureus (56.6%), 14.7% of which were methicillin resistant staphylococcus aureus, and staphylococcus epidermis (5%). 9.1% of microorganisms were polymicrobial. The infected line was removed in 92.5% of patients. Average hospitalisation duration was 10 days. 7.5% required ICU admission. Other complications included: death (7.5%), infective endocarditis/aortitis (5%) and spinal infection (3.3%).
Conclusions
Indigenous New Zealanders were over-represented in the HD-CRBSI cohort. Staphylococcus aureus was the most frequently isolated microorganism, followed by staphylococcus epidermis. HD-CRBSIs have considerable morbidity and mortality consequences as seen by the small but significant proportion of patients needing ICU and developing serious complications including metastatic infections and death.