Central line infections in Chronic kidney disease patients on Hemodialysis

                  INTRODUCTION

Patients with ESRD who are on maintenance Hemodialysis ,are at increased risk of blood stream infections ,due to frequent blood handlings .

Infection depends on patient related factors , dialysis related factors ,and catheter handling ,host factors .

Here I report few patients with Catheter related blood stream infections - causing systemic infections like infective endocarditis ,Severe sepsis , Meningoencephalitis,spondylodiscitis.

1-. Long standing Permacath causing Infective endocarditis - Tricuspid valve vegetation.

Below is the case link 

 https://pavangadila123.blogspot.com/2021/11/a-45-yr-old-male-patient-church-pastor.html

This patient was started on Hemodialysis  2 years back ,as his  AV fistula failed permacath was inserted into left subclavian vein 8 months back ,since then he is undergoing dailysis through this permacath

Patient had sudden onset of shortness of breath ,with fever chills and hypotension during dailysis and we had to Shift him to ICU from dailysis unit .

After sending routine investigations his Total WBC counts were - 25K with neutrophilic leucocytosis and thrombocytopenia .

In view of septic shock Ionotropes are started and Inj .PIPTAZ according to renal clearance was started ,later escalated to meropenam .

2D echo showed Tricuspid valve vegetation .

Cultures from central and peripheral blood grown - Klebsiella species 

Satisfying the criteria of CRBSI 

Complications we anticipated were - Pulmonary embolism .

Patient had sudden onset of SOB and beacme unresponsive.

CPR was initiated and continued but unfortunately he couldn't be revived back .

2- Central line infection - causing Meningoencephalitis and Disseminated intravascular coagulation - purpura Fulminans

Below is the case link

 http://shubhasri-112.blogspot.com/2021/11/50-yr-old-male.html

 

This patient had Right IJV Central line catheter for 4 months despite after repeated counselling .

As it was not functioning it was removed and right femoral catheter was placed since 1 week .

Patient presented with high grade fever and chills ,altered sensorium ,unable to speak since 1 day.

On examination patient is Altered ,aphasic , meningeal signs + ve 

Kernigs+ 

Brudzinskis + 

CSF analysis showed 

Low sugars 

TC-1300 with neutrophilic predminance 

Bacterial / Tubercular meningitis