Risk factors for catheter-related colonisation and catheter-related bloodstream infection in chronic haemodialysis patients with cuffed tunneled central venous catheters
Abstract number: P1185
Aguinaga A., del Pozo J.L., García-Fernández N., Serrera A., Alonso M., Guillén-Grima F., Leiva J.
Objectives: Catheter-related bacteraemia is a major cause of morbidity and mortality among catheter dependent haemodialysis patients. The aim of this study was to analyse risk factors for catheter colonisation (CC) and catheter related bloodstream infection (CRBI) in chronic haemodialysis patients with cuffed long term tunneled central venous catheters.
Methods: From July 2003 to January 2006, we conducted a prospective study to detect CC, and establish a pre-emptive therapy based in catheter antibiotic lock in order to prevent development of CRBI in haemodialysis patients. Risk factors for CC and CRBI in 35 patients with 45 catheters were assessed. Patient demographic and clinical characteristics and catheter characteristics were assessed for theirs relationship to CC and CRBI in haemodialysis patients. These characteristics were analyzed by Kaplan-Meier survival curves. Statistical differences between survival curves were determinated by the log rank test. A multivariate Cox's proportional hazards model was applied testing in the model those variables that obtained p values lower than 0.1 in the log rank test to assess the independent risk factors for CC and CRBI.
Results: As risk factors for CC were identified: diabetes mellitus (Hazard ratio (HR)=17.55, 95% CI, 2.91105.99, p = 0.002), obesity (HR=13.01, 95% CI, 1.9985.22, p = 0.007), previous CRBI episodes in the same catheter (HR=11.77, 95% CI, 1.27108.62, p = 0.030) and duration of catheter use (HR=4.46, 95% CI, 1.1617.18, p = 0.030). S. aureus nasal carriage (HR=9.23, 95% CI, 1.2269.62, P = 0.031), obesity (HR=4.27, 95% CI, 1.0617.14, P = 0.040), early detection of CC (HR=3.72, 95% CI, 0.9913.87, P = 0.050) and duration of catheter use (HR=3.57, 95% CI, 1.528.36, P = 0.003) were identified as risk factors for CRBI. S. aureus nasal carriage was risk factor in CRBI episodes caused by S. aureus ('c2' = 5.585, P = 0.018) and was not risk factor in CRBI episodes caused by other organisms different than S. aureus ('c2' = 1.150, P = 0.284).
Conclusions: Diabetes mellitus was the most important risk factor for CC. S. aureus nasal carriage was the most important risk factor to S. aureus CRBI. Obesity and early diagnosis of CC were independent factors associated with high risk of CRBI. Obesity and duration of catheterisation were common factors that increased risk of CC and CRBI. Possible preventive actions can be made according to these risk factors.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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