Hemodialysis Catheter-Related Sepsis
Author(s):
Badi H, Marhoum El Filali K, Oulad Lahcen A, Marih L, Sodqi M, Chakib A, Amouzoune M, Asad K, Mtioui N, Khayat S, Zamd M, Medkouri G, Benghanem Gharbi M, Ramdani B, Safir S and Habbal R
Introduction: Hemodialysis (HD) patients are exposed to various complications. Infectious complications are the second leading cause of morbidity and mortality after cardiovascular complications. The aim of our study is to describe the clinical, paraclinical and bacteriological aspects of the HD catheter-related infection.
Patients and methods: We carried out a retrospective study over a period of one year, involving 25 HDs patients hospitalized in the Department of Infectious Diseases, Cardiology and Nephrology of Ibn Rochd University Hospital Center in Casablanca.
Results: The majority of these patients were male (72%) with an average age of 59 years. Twenty patients had a jugular catheter. Fever was the main symptom found in all patients, associated with sepsis signs in 88% of cases, while 12% of patients were classified as a septic shock. All patients had a biological infectious syndrome with leukocytosis and positive CRP. Peripheral and catheter-based blood cultures, and culture of the distal tip of the catheter were performed in all patients., allowing the determination of the causative germ in 72% of the cases. The most frequently isolated germs were Staphylococcus aureus (66.7%), Gram-negative bacilli (16.7%), coagulase-negative staphylococci (11.1%), and Candida sp (5.5%). All patients received a probabilistic antibiotherapy based on vancomycin and amikacin combination adapted to the renal function andthe antibiogram results thereafter. Six patients had associated endocarditis. The evolution was favourable in 76% of the patients. Six patients died. The main cause of death is the septic shock (3 cases).
Conclusion: Vascular access in HD deserves special attention. The prevention of infectious complications in this category is based on compliance with hygiene rules and the temporary use of catheters and then the creation of native arteriovenous fistula.