DR JESSICA PHILLIPS1, DR DORIS CHAN1, DR ARON CHAKERA1, DR RAMYASUDA SWAMINATHAN2, DR KHALIL PATANKAR3, HEALTHCARE ASSOCIATED INFECTION UNIT DEPARTMENT OF HEALTH WESTERN AUSTRALIA4, DR NEIL BOUDVILLE1, DR WAI LIM1
1Sir Charles Gairdner Hospital, Nedlands, Australia, 2Fiona Stanley Hospital, Murdoch, Australia, 3Royal Perth Hospital, Perth, Australia, 4Healthcare Infection Surveillance Western Australia (HISWA), East Perth, Australia
Background: Catheter-related bloodstream infection (CRBI) is an important complication of catheter use for haemodialysis (HD), but it remains unclear whether clinical outcomes following CRBI are influenced by organism type.
Aims: 1) To evaluate the temporal and antibiotic resistance patterns of CRBI, and 2) To compare the clinical outcomes following CRBI from Gram-positive and non-Gram positive organisms.
Methods: This was a retrospective cohort study of patients initiated on HD via tunnelled or non-tunnelled vascular catheters with an episode of CRBI in Western Australia between 2005 and 2018. The associations between organism type and likelihood of hospitalisation, catheter removal and death from CRBI were examined using adjusted logistic regression models.
Results: Of 111 episodes of CRBI, fifty three (47.7%) patients were male and thirty eight (34.2%) identified as Aboriginal or Torres Strait Islander. Gram-positive CRBI was identified in seventy three (65.8%) patients, most commonly Staphylococcus aureus. Of those with non-Gram-positive CRBI, nine (23.7%) were attributed to Pseudomonas aeruginosa. The proportion of Gram-positive CRBI increased over time, from 38% of overall CRBI in 2007-2009 to 87% in 2016-2018, predominantly explained by the increase in MSSA CRBI. One hundred and two (91.9%) patients were hospitalised and fifteen (13.5%) patients died from CRBI. Compared to patients who had experienced non-Gram-positive CRBI, those with Gram-positive CRBI were more likely to require hospital admission and catheter removal, with adjusted OR of 9.34 (95%CI 1.28, 68.03) and 3.47 (95%CI 1.25, 9.67), respectively. There was no association between organism type and odds of death from CRBI.
Conclusion: Staphylococus aureus remains the most common organism causing CRBI. CRBI is associated with substantial morbidity, particularly CRBI attributed to Gram-positive organisms.