LAUSR

Tunneled central venous catheter (T CVC) use is rising among patients undergoing chronic hemodialysis (HD) and non-tunneled (NT) CVCs are often used for HD initiation in late referral chronic kidney disease (CKD) or acute kidney injury (AKI). Catheter-related bloodstream infections (CRBSI) are a major complication of CVC use. This study examines potential patient- and CVC- related factors associated with CRBSI incidence and its microbiological features. In this retrospective single-center study, 413 patients undergoing an extracorporeal treatment (HD or Plasma Exchange) between February 1st 2014 and January 31st 2017 with 561 CVCs were recruited. Clinical data at study entry and CVC type are summarized in table 1. All bloodstream infections (BSI) occurring during the observation period were recorded and classified into CRBSI or non-CRBSI (nCRBSI), and their infecting agents collected. An incidence rate ratio (IRR (95% CI)) was calculated to assess the association between CRBSI incidence rate (IR), expressed as events/1000 catheter-days, and each clinical variable or CVC type. Significant associations at the univariate analyses were investigated with multivariate cox models. During a cumulative follow-up time of 66686 catheter-days, 54 (IR: 0.81) CRBSI and 30 (IR: 0.45) nCRBSI events occurred. CRBSI had higher frequency of GRAM+ bacteria compared with nCRBSI (70% vs 33%, p<0.001). Among CRBSI, GRAM- bacteria were more frequent in patients with age <80y (16 (36%) vs 0, p=0.02), and T CVC (40% vs 18%, p=0.07). At the univariate analysis, male sex, age <80y and AKI were associated with higher CRBSI IR (table 2). Compared with T Jugular CVC, higher CRBSI IR was associated with NT Jugular (IRR 6.45 (2.99-13.56), p<0.0001) and NT Femoral (IRR 12.90 (5.87-27.61), p<0.0001) CVC; T Femoral CVC was associated with higher non-significant IR (IRR 2.45 (0.93-5.85), p=0.07). At the multivariate analyses, factors associated with higher CRBSI IR were AKI (hazard ratio - HR 3.03 (1.38–6.67), p=0.006), NT CVC (HR 3.11 (1.30–7.41), p=0.01), and Femoral CVC (HR 2.63 (1.36–5.07), p=0.004). Patients affected by AKI and use of NT or Femoral CVCs are independently associated with CRBSI risk.