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Kidney Week

Abstract: FR-PO759

Characteristics of Hospital Acquired Central Line Associated Bloodstream Infection (CLABSI) in Hemodialysis (HD) Patients in a Single Tertiary Medical Center in Hawaii

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Klomjit, Nattawat, John A. Burns School of Medicine. University of Hawaii, Honolulu, Hawaii, United States
  • Tantisattamo, Ekamol, University of California, Irvine School of Medicine, Orange, California, United States
Background

Hospital acquired CLABSI is one of an important complication of dialysis catheter and is associated with high morbidity and mortality in HD patients. We studied baseline characteristics of HD patients who developed hospital acquired CLABSI as part of our institutional quality improvement project.

Methods

We identified index patients through the hospital database based on CDC definition of CLABSI. We studied the hospital acquired CLABSI patients who had HD catheter presented at the time of CLABSI diagnosis between 1/1/12 and 12/31/17. We studied baseline characteristics, hospital-related factors, and mortality rate associated with CLABSI.

Results

Of the 13 patients, 46% were male and median± SD age was 66±11.28 years old. Asian is the most prevalent (46%) followed by mixed race (31%). There were no Caucasian patients in the cohort. More than half had diabetes. Infection (46.2%) was the most common admitting diagnoses followed by cardiovascular diseases (30.1%). The majority of patients had ESRD (69.2%) followed by AKI on CKD (23.1%), and AKI (7.7%) and two-third of the patients infected tunneled HD catheter (TDC) and the remaining one-third had non-TDC. A quarter of patients (23%) was in ICU when CLABSI was diagnosed. Only 38% of blood cultures were drawn from peripheral sites and central line. Up to 31% had an early CLABSI occurred within 7 days after HD catheter placement. Gram positive cocci is the most common pathogens (54%), followed by gram negative bacilli (31%), anaerobe (8%), and fungus (7%) and 85% of cases were managed by infectious disease physicians. Median length of hospital and ICU stays were 21 and 17 days, respectively. In-hospital mortality rate was 15.4%.

Conclusion

Our patients are elderly with diabetes mellitus being the major co-morbidities. There are unexplained racial disparities of races given no Caucasian patients in our cohort. The majority of hospital acquired CLABSI occurred in ESRD patients and the prevalence of infected TDC was greater than that of non-TDC. A third of patients developed CLABSI within 7 days of HD catheter placement therefore strict measures should be employed during this phase to prevent early HD catheter infection.