Hemodialysis catheter-related infections: Results of a tertiary care center study in Saudi Arabia

Background: Catheter-related bloodstream infection (CRBSI) is frequent causes of mortality and morbidity in dialysis patients, and the sensitivity pattern of antimicrobials varies across different dialysis centers. Objectives: The present study aimed to investigate the pattern of microbes grown from catheter sites, blood and the sensitivity pattern. The data could help in initiating an empiric antimicrobial therapy. Materials and Methods: This was an observational retrospective study at Regional Kidney Center at King Abdul Aziz Specialist Hospital, Taif, in the western region of Saudi Arabia. The data collected were related to patients’ demographics, etiology of renal failure, presence of comorbidities, site of catheter insertion, and duration. Furthermore, microbiological data including cultures from catheter sites, blood, and catheters’ tips and antibiotic sensitivity. Results: Data on 130 patients (66 females, 50.8%) undergoing hemodialysis from June 2017 to March 2018 were analyzed. The infection rate was 23.6% in this study. In all patients with CRBSI, the catheters were removed, and antibiotics given. The highest infection rates (38.4%) were noted with femoral vein inserted catheters. However, the clinical sepsis was more with jugular catheters. Staphylococcus aureus was prevalent organism, and cephalosporins had the highest sensitivity. Ten catheters found to be mal functional were replaced. Conclusion: Chronic kidney disease patients with diabetes and ischemic heart disease were more prone to CRBSI. Femoral catheters had significantly higher infection rates. S. aureus was the most common type of isolated bacterial strain and cephalosporins showed the highest sensitivity for the isolated bacteria.

Spirocheatal shock syndrome.

In this paper we describe a clinical scenario of high grade fever, jaundice, hypotension and multi‑organ dysfunction syndrome in a 30‑year‑old homeless male without radiological biliary obstruction. He was brought to our hospital by the emergency medical service of Saudi Arabia (Red Crescent) from the street. After an initial resuscitation he proved to have Borrelia recurrentis. The clinical course during his hospital stay was not a smooth one, but the patient finally improved. After 20 days of hospitalisation, he was discharged in a stable condition. The present case underlines the need for high clinical vigilance, even in a non‑endemic area.

Acute renal failure due to leukaemic infiltration of kidneys.

Three patients with acute lymphatic leukaemia who presented with non-oliguric acute renal failure resulting from leukaemic infiltration of the kidneys are reported. Chemotherapy resulted in clinical remission of leukaemia with regression of renal size and prompt improvement in renal function in two cases. The third patient died on the second day of therapy and a post-mortem renal biopsy revealed dense leukaemic infiltration of the kidneys. Early institution of specific chemotherapy for leukaemia, maintenance of fluid and electrolyte balance, and dialytic support whenever indicated may prove helpful in prevention of serious complications associated with renal failure and in halting further ischaemic injury to the kidney.