OUTCOME OF BACTERIAL CULTURE IN SAMPLES FROM AV FISTULA AND CENTRAL VENOUS CATHETER: A STUDY IN BANGABANDHU SHEIKH MUJIB MEDICAL UNIVERSITY, DHAKA, BANGLADESH

Md. Siddiqur Rahman*, Md. Shahidul Islam (Selim), Md. Ruhul Amin, Md. Ajfar Sazid Khan and
Salina Akter

ABSTRACT

Introduction: Bloodstream infections are the second most common cause of death among patients on hemodialysis. Since data on vascular access complications are scarce, this study was designed to focus on vascular access complications in hemodialysis patientsInfection is the second leading cause of death in hemodialysis patients in many countries and is the leading cause of death. Furthermore, infection is a major cause of hospitalization in hemodialysis patients. Objective: The purpose of the present study was to estimate the Outcome of Bacterial Culture in Samples from AV Fistula and Central Venous Catheter. Methods: This cross sectional study was conducted from January 2014 to December 2015 for a period of 2(two) years in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University, Dhaka. All adult patients underwent hemodialysis of both sexes fulfilling the inclusion and exclusion criteria were included in the study. Then each patient was evaluated during each hemodialysis session for the two samples were sent for cultures one from peripheral veins and another from vascular access either from fistula or from central venous catheter. Result: The mean age of the patients were 38.26 (15.26) years. In this present study male (71.7%) are predominant than female (28.3%). Maximum (51.7%) patients were under weight. In this study 50 (83.3%) patients had anemia. Mean (SD) WBC, Hb, S. uric acid, FPG, Plasma glucose 2h ABF, HbA1C, S. total protein and S. albumin were 14415 (4000) count/cmm, 9.61 (1.62) g/dl, 417.67 (100.87) μmol/l, 5.37 (1.18) mmol/l, 7.27 (2.18) mmol/l, 6.42 % (0.68), 62.71 (5.82) g/l and 28.97 (4.99) g/l respectively. Out of 46 AV fistula cases, culture was positive in vein 8 (13.3%) cases and in fistula 5 (10.8%) cases. Out of 11 permanent CV catheter cases, culture was positive in vein 6 (54.5%) cases and in catheter 7 (63.3%) cases. Out of 3 catheter tip cases, culture was positive in catheter tip 2 (66.7%) cases. Comparison of growth between AV fistula and central venous catheter site. Positive growth was significantly higher in central venous catheter 9 (64.3%) than that of AV fistula 5 (10.9%) cases. Conclusion: We identified a high incidence of catheter-related infections caused by resistant microorganisms in patients undergoing hemodialysis via central venous catheters. The risk of BSI in patients undergoing hemodialysis is related to the vascular access (tunneled central venous catheter), low haemoglobin, underweight, low serum total protein and low serum albumin.

Keywords: Bacteremia, Hemodialysis, Blood stream infection, Epidemiology, Infection control.