Haemodialysis catheter related infections among patients undergoing maintenance haemodialysis in the renal unit - Kenyatta National Hospital

Abstract

Background Vascular access is the "Achilles heel" of haemodialysis. Different types of angioaccess are in use and of this, catheters constitute the majority. One of the major drawbacks to the catheter accesses is various forms of catheter- related infections. These infections constitute a significant contribution towards the morbidity and mortality so often observed among haemodialysis patients. Objective To determine the prevalence of haemodialysis catheter related infections and associated risk factors among patients undergoing maintenance haemodialysis at the renal unit of the Kenyatta National hospital Design Cross-sectional descriptive study. Setting Renal unit of the Kenyatta National Hospital. Study population Patients on maintenance haemodialysis who had a temporary, uncuffed subclavian catheter or a permanent, cuffed internal jugular vein catheter for haemodialysis were recruited. Baseline data including temperature, blood pressure, pulse rate and respiratory rate were taken and recorded. A physical examination was also carried out before blood for haemogram, serum albumin and culture was drawn. Exit site swabs and tips of removed catheters were cultured and any bacterial isolates were subjected to sensitivity tests against selected antibiotics. Associated risk factors, age, sex, type of catheter (cuffed versus uncuffed), duration of catheter stay,albumin and diabetes for the catheter related infections were assessed sults: Fifty seven patients with either a subclavian catheter or an internal jugular catheter were recruited into the study. The mean age of the patients was 46.32 ± 2.0 yrs with 40 %( 23) females and 60 %( 34) males. Forty nine percent of the patients had a subclavian catheter while 51 %( 29) had an internal jugular vein catheter. The mean serum albumin within the study group was 44.286± 1.286 g/dl, mean haemoglobin 8.531±0.24g1dl and the mean temperature was 36.90c. The commonest reason for catheter change within the preceding six months was due to catheter related infection. Thirty five percent of the patients reported use of antibiotics due to catheter related infection within the preceding one month. The commonest type of catheter related infection was exit site infection with a prevalence of 58% followed by tunnel infection with 14% prevalence. Staphylococcus aureus was the commonest organism cultured from both exit site and blood with high sensitivity to many of the commonly used antibiotics. One patient had an MRSA. There was no relationship between infection and level of albumin, age, catheter type or diabetes but females weremore likely to get exit site infection than males. Conclusion: Exit site infection is the commonest type of catheter infection among patients undergoing chronic haemodialysis using catheters in the renal unit of Kenyatta National Hospital. Staphylococcus aureus is the commonest cause and is highly sensitive to commonly used antibiotics.