# A Prospective Observational Study on the Clinical and Microbiological Profile of Catheter-Related Blood Stream Infections in Hemodialysis Patients and Their Outcome in a Tertiary Care Centre in Northeast India

## TL;DR

This study examines bloodstream infections in hemodialysis patients in India, finding high infection and mortality rates linked to catheter use.

## Contribution

The study provides a clinical and microbiological profile of CRBSIs in a high-risk hemodialysis population in a low-resource setting.

## Key findings

- CRBSI incidence was 10.08 episodes per 1,000 catheter-days, with 31.3% in-hospital mortality.
- Gram-negative bacilli were the most common pathogens, and non-survivors had higher rates of Gram-negative infections.
- Culture positivity was higher among non-survivors, but catheter dwell time did not differ between groups.

## Abstract

Introduction: Catheter-related bloodstream infections (CRBSIs) are major complications for hemodialysis patients dependent on central venous catheters (CVCs). Variations in infection control practices and prolonged catheter use amplify the risk and lead to increased morbidity, mortality, and healthcare costs.

Objectives: This study aimed to determine the clinical and microbiological profile of CRBSIs in hemodialysis patients and to assess the outcomes, including in-hospital mortality.

Methodology: This prospective observational study was conducted in the Department of Nephrology, Gauhati Medical College, in Guwahati, Assam, India, from May 2024 to April 2025. A total of 67 adult patients (≥18 years) undergoing maintenance hemodialysis with tunneled or non-tunneled CVCs and clinically suspected CRBSIs were enrolled. CRBSI was defined using the Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA) criteria. Patients with alternative identifiable infection sources or incomplete microbiological data were excluded.
Baseline demographics, comorbidities, clinical presentation, laboratory parameters, catheter characteristics, microbiological profile, treatment, and in-hospital outcomes were obtained from medical records using a standardized data collection form. Blood cultures were obtained aseptically prior to antibiotic initiation, including paired peripheral and catheter-drawn samples. Samples were processed using the BACTEC system, and organism identification was performed using the VITEK 2 system in accordance with standard microbiological protocols.

CRBSI incidence was calculated as episodes per 1,000 catheter-days. Clinical outcomes assessed included catheter removal, length of hospital stay, and all-cause in-hospital mortality. Continuous variables were expressed as mean ± standard deviation or median (interquartile range), and categorical variables as frequencies and percentages. Univariate comparisons were performed using Student’s t-test for continuous variables and Chi-square or Fisher’s exact test for categorical variables, as appropriate. Variables with a p-value <0.10 on univariate analysis were entered into the multivariate logistic regression model. A p-value <0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics.

Results: The mean age was 48.2 ± 12.8 years, and 62.7% of patients were male. Diabetes and hypertension were the leading causes of end-stage kidney disease (ESKD) (44.8%), indicating a high-risk cohort with prolonged catheter exposure. Total catheter exposure was 6,645 days, with a CRBSI incidence of 10.08 episodes per 1,000 catheter-days. Blood cultures were positive in 74.6% of cases, yielding Gram-positive cocci (34.8%), Gram-negative bacilli (39.0%), and fungi (1.5%), while 25.4% remained culture-negative. In-hospital mortality was 31.3%. Non-survivors showed higher rates of Gram-negative infection (55.0% vs. 36.2%; p = 0.04) and culture positivity (85.0% vs. 70.2%; p = 0.08). Median catheter dwell time was similar between groups (1.5 months each; p = 0.17).

Conclusion: The observed CRBSI incidence and mortality exceeded rates reported in high-resource settings. Early arteriovenous fistula creation, strict adherence to aseptic protocols, and empiric antimicrobial regimens covering both Gram-positive and Gram-negative organisms are urgently required.