Dialysis Central Venous Catheter–Associated Sepsis: Complimentary Role of Local Susceptibility Pattern
Peter Kehinde Uduagbamen *
Department of Internal Medicine, Division of Nephrology and Hypertension, Bowen University, Iwo/Bowen University Teaching Hospital, Ogbomosho, Nigeria and Department of Internal Medicine, Division of Nephrology and Hypertension, Babcock University / Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
Folasade Olubunmi Soyinka
Department of Internal Medicine, Division of Nephrology and Hypertension, Babcock University / Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
Titilope A. Bamikefa
Department of Medicine, Renal Unit, UniOsun Teaching Hospital, Oshogbo, College of Health Sciences, Osun State University, Oshogbo, Nigeria.
Michael Gbenga Israel
Department of Internal Medicine, Dermatology Unit, Bowen University Teaching Hospital, Ogbomosho, Nigeria and Department of Internal Medicine, Dermatology Unit, Ladoke Akintola University Teaching Hospital (LAUTECH), Ogbomosho, Nigeria.
Osaze Ehioghae
Department of Internal Medicine, Division of Nephrology and Hypertension, Babcock University / Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
Sandra Olufunmilayo Idris
Department of Internal Medicine, Division of Nephrology and Hypertension, Bowen University, Iwo/Bowen University Teaching Hospital, Ogbomosho, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Effective treatment of central venous catheters infections could be very challenging, and may require catheter removal. Reinsertion could worsen the economic burden on patient, particularly those paying out of pocket.
Methods: Management was anchored on dialysis-based nitrogenous waste, antigen and cytokines clearance, in addition to antibiotic treatment that was based on sensitivity results and, local microbial susceptibility pattern, to minimize cost.
Results: He was febrile (38.40C), had a non-tunnelled jugular vein catheter with a dirty, wet dressing with a greenish tinge. He had tachycardia (110/min), fine crepitaions in the lung bases and ascites. Blood and central line samples grew Pseudomonas aeuriginosa sensitive to Imipenem ++ (both), Vancomycin + (blood) and Ciprofloxacin + (central line). He had 4 haemodialysis sessions through the infected catheter, a dose of Vancomycin but none of Imipenem (on account of cost). He had a full course of intravenous Ciprofloxacin and Ceftazidime which was introduced on the basis of local microbial susceptibility pattern as it had been very effective in managing infective conditions in our CKD patients (either in mono or in combination therapy), particularly in patients unable to afford culture and sensitivity test . He had a good clinical and, microbiological recovery as a repeat culture after seven days of antibiotics treatment showed no growth. The catheter was retained for use in further dialysis sessions.
Conclusion: Treatment of infected non-tunnelled dialysis catheters could be very challenging particularly in resource poor settings. The use of low cost antibiotics with positive local microbial susceptibility pattern could be very beneficial, additive and effective in treatment and in minimizing complications.
Keywords: Antibiotics, haemodialysis, central venous catheters, culture, susceptibility, infections