|
Title Epidemiology of tunneled dialysis catheter (TDC) associated bacteremia: An observational study |
|
Type Poster Presentation |
|
Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
|
Topic Dialysis: Vascular Access |
|
Main Author Ian Tatt Liew1 |
|
Presenting Author Ian Tatt Liew1 |
|
Co-Author TIMOTHY JK KOH1 |
|
Department / Institution / Country Renal Medicine / Tan Tock Seng Hospital / Singapore1 |
Abstract Content: Introduction, Method, Result, ConclusionBackgroundWe aimed to assess the epidemiology and microbiology of patients with TDC associated bacteremia. MethodsWe conducted a retrospective cohort study of patients admitted between 1st January 2014 to 31st December 2015 with TDC associated culture-positive bacteremia. Patients with alternative source of bacteremia were excluded. Results121 bacteremic episodes were documented from 91 patients. 85% of cases were diabetic, 69.4% male.
Mean age was 61.1 years (median 62.1). Mean dialysis vintage was 1.58 years (median 0.91). Mean catheter vintage (time of TDC placement to bacteremia) was 185 days, median 84 (Range 1-1548 days).
Gram-positive organisms were isolated in 62% of cultures (75/121), gram-negative organisms in 42% (52/121). 12.4% of cultures (16/121) showed polymicrobial bacteremia (PMB). Gram-positive bacteremia (GPB) isolated in 62.9% (66/105) and gram-negative bacteremia (GNB) in 37.1% (39/105) of monomicrobial cultures. Commonest gram-positive organisms were Methicillin-resistant Staphylococcus Aureus (MRSA) (n=27), Methicillin-sensitive Staphylococcus Aureus (MSSA) (n=16), and Staphylococcal species (n=15). Commonest gram-negative organisms were Pseudomonas (n=17), Klebsiella (n=9) and Escherichia Coli (n=7). 84% of MRSA GPB (21/25) were MRSA carriers compared to 16% in non-MRSA GPB (7/43 cases), p < 0.01. The odds of patients developing MRSA bacteremia having MRSA carriage was 25, p <0.01.
Complications (septic shock, metastatic septic foci, High Dependency admission or death) occurred in 35.5% (43/121) with higher prevalence in PMB compared to GPB (9/16 vs 20/66, p= 0.051).
There was no difference between femoral vs non-femoral TDCs and prevalence or microbiology of bacteremia. Fresh inserted TDCs had longer catheter vintage compared to guidewire exchanged TDC but was not statistically significant (206 days vs 129 days, p= 0.17).
ConclusionEmpiric antibiotic cover for Staphylococcus should be administered for suspected TDC bacteremia in our institution with MRSA cover enforced in MRSA carriers. |