P1350A COMPARISON OF CENTRAL VENOUS CATHETER INFECTIONS FOR HEMODIALYSIS AND HEMATOLOGY PATIENTS
Authors: Murt Ahmet , Dincer Mevlut Tamer , Ercaliskan Abdulkadir , Karaca Cebrail , Elverdi Tugrul , Trabulus Sinan , Ar M Cem , Altiparmak Mehmet Riza , Seyahi Nurhan 
Published: June 2020

Abstract

Background and Aims
In addition to nephrologists who use central venous catheters (CVCs) as venous access for hemodialysis, it is also a routine practice for hematologists to benefit from them for their medical applications. There may be immediate or delayed complications of CVC placement and infections are accepted as delayed complications. We aimed to compare CVC-related infections in hematology and hemodialysis patients groups both of whose CVCs were placed by interventional nephrologists. Group specific infectious agents as well as infection risk factors were analyzed in order to develop guides and practices to decrease infection rates for the future.

Method
The number of patients who were placed a CVC in bone marrow transplantation (BMT) unit was 69 (37 males, 32 females) in the year of 2019. These patients were 47,5 ± 14,3 years old. Their CVC infection numbers and rates as well as infection agents were analyzed. This group was compared with hemodialysis patients that have non-cuffed hemodialysis catheters and who were age and sex matched with the BMT group. Infection rates for 1000 catheter days were calculated separately for both groups. Catheter infections were defined as hemoculture positivity of samples obtained from catheter lumens and/or identification of any microorganism in the catheter tip. Cases were followed up from insertion day of the catheters until when infection was identified or until the day of catheter removal.

Results
Catheters remained in a central vein for a median of 25 days in hemodialysis group [range: 10-51 days] while these duration was 16 days [range:8-29 days] for BMT group. The number of cases in whom a catheter related infection was identified was 17 for BMT (24%) and nine (13%) for hemodialysis group. Infection rate was 23 for 1000 catheter days in BMT group while it was 11 for 1000 catheter days in hemodialysis patients. BMT patients have a wider range of infection agents; 78% of them being gram positives and 19% of them being gram negatives. It was noteworthy that all of the catheter related infections in hemdialysis patients were related to gram positive bacteria. Rate of infections due to extended spectrum beta lactamase (ESBL) secreting E.coli or Klebsiella was 24% and infection risk of ESBL secreting agents was directly proportional to the time spent with the catheter. Infection findings in the catheter exit site (e.g. erythema, crusts or effusions) was found as statistically significant risk factors for bloodstream infections in BMT patients while these factors were not statistically significant for hemodialysis patients.

Conclusion
Gram positive infections make up the majority of CVC-related infections both for hematology and hemodialysis patients. Infection risks due to resistant species is proportional to the time spent with catheters. Catheter exit site findings should be cautionary for probable bloodstream infections especially for immunosuppressed patients.