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Clinical presentation and outcome of hemodialysis tunneled catheter-related bloodstream infection in older persons

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Key summary points

AbstractSection Aim

To compare clinical characteristics, microbiology, and outcomes of tunneled catheter-related bloodstream infections among old (aged ≥ 75) versus younger chronic hemodialysis patients.

AbstractSection Findings

The clinical presentation among old versus younger patients’ groups was similar. However, the rate of resistant pathogens was considerably higher among older adults. Overall mortality rate (in-hospital and 90-day mortality) was high in both groups.

AbstractSection Message

Poor clinical outcome following an episode of catheter-related bloodstream infection among old hemodialysis patients suggests that the use of tunneled catheters as a permanent vascular access should be discouraged.

Abstract

Background

The use of a tunneled catheter as the primary vascular access among old hemodialysis patients is frequent. Catheter-related bloodstream infection (CRBSI) is a common complication, associated with increased mortality. Data regarding the clinical presentation and outcomes of CRBSI among old hemodialysis patients is limited.

Methods

All chronic hemodialysis patients hospitalized between 2010 and 2022 with CRBSI were included. Patients were classified into two groups: old adults (≥ 75) and younger patients. Clinical, microbiological, and outcome data were collected and analyzed.

Results

One hundred and fifty-four patients with CRBSI were identified. Fifty-seven were aged ≥ 75 years. Mean age in the older and younger groups was 81.2 ± 5 and 59.7 ± 12.7, respectively. Male gender was predominant (64%). Charlson comorbidity score and Pitt bacteremia score were comparable among both groups. Norton score < 14 was more common among old persons (n = 24, 67% versus n = 21, 31%, p < 0.001), as well as nursing-home residence. Gram-negative pathogens and Staphylococcus aureus were common in both groups. The frequency of inappropriate empirical antimicrobial treatment was higher among older persons. Overall, in-hospital and 90-day mortality was high (age ≥ 75, 36.8%, age < 75, 24.7%, p = 0.14). Age was not significantly associated with mortality after adjustment for low Norton score, residence, and inappropriate antimicrobial therapy as well as resistance patterns of bloodstream isolates [OR = 1.2 (95% CI 0.4–3.3), p = 0.76].

Conclusions

Clinical characteristics and outcomes of CRBSI were comparable among old and young hemodialysis patients. However, the high mortality rate in this cohort suggests that the use of tunneled catheters as a permanent vascular access should be discouraged in both patient groups.

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Authors and Affiliations

  1. Institute of Nephrology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel

    Alon Bnaya, Jawad Atrash & Linda Shavit

  2. Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel

    Yuval Schwartz, Orit Wolfovitz Barchad & Eli Ben-Chetrit

  3. Pediatric Infectious Diseases, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel

    Maskit Bar-Meir

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  1. Alon Bnaya
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Correspondence to Eli Ben-Chetrit.

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The study was approved by SZMC institutional review board (approval number: 0180-22-SZMC).

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41999_2023_861_MOESM1_ESM.jpg

Supplementary file1 Resistance patterns of bloodstream isolates in the study groups. The overall rate of drug-resistant pathogens was significantly higher among older patients [37/57 (64.9%) versus 41/97 (42.3%), p=0.008]. AmpC beta lactamsaes; ESBL, extended spectrum beta lactamases; MDR, multi-drug resistant; MRSA, methicillin-resistant Staphylococcus aureus; CRAB, carbapenem resistant Acinetobacter baumannii. Three cases of candidemia were excluded (JPG 58 KB)

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Bnaya, A., Schwartz, Y., Wolfovitz Barchad, O. et al. Clinical presentation and outcome of hemodialysis tunneled catheter-related bloodstream infection in older persons. Eur Geriatr Med 15, 235–242 (2024). https://doi.org/10.1007/s41999-023-00861-3

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  • DOI: https://doi.org/10.1007/s41999-023-00861-3

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