Abstract
BACKGROUND AND AIMS: Catheter-associated bloodstream infections (CABSI) cause a significant clinical and financial burden in nephrology. This study aimed to identify the clinical risk factors and prevalent pathogens associated with CABSI among hemodialysis (HD) patients at a tertiary care hospital in Pakistan. METHODS: This cross-sectional study included 150 patients (aged 18 years or older) with CABSI undergoing HD via central venous catheters (tunneled and non-tunneled) at CMH Hospital, Multan, over a 6-month period. We recorded clinical details and collected dual blood samples (catheter and peripheral vein) for culture assessment. The primary outcomes were identifying clinical risk factors and determining the prevalence of causative bacterial pathogens. RESULTS: The mean age of the sample was 61.91 ± 8.02 years, comprising 60.66% males and 39.33% females. The average duration of the catheter was 38.59 ± 18.7 days. Gram-negative bacteria (83/150, 55.33%) were more prevalent than Gram-positive bacteria (67/150, 44.66%) in these infections, with the most common pathogens being Pseudomonas aeruginosa (27/150, 18.00%) and Methicillin-resistant Staphylococcus aureus (MRSA) (25/150, 16.67%). Modifiable risk factors included prolonged catheter use (> 30 days), femoral site insertion, underlying comorbidities, and anemia. CONCLUSION: Prolonged catheter use and femoral insertion are major modifiable risk factors for CABSI in hemodialysis patients. With Gram-negative pathogens like Pseudomonas aeruginosa and MRSA predominantly responsible, targeted empirical antimicrobial strategies and early arteriovenous fistula creation are crucial to mitigate infection risks in resource-limited settings.