Epidemiology and outcome of exit site infection catheter related among patients from a Brazilian haemodialysis unit

Patients undergoing haemodialysis (HD) are at high risk for healthcare-associated infections. There are scarce data on epidemiology of exit site infection (ESI) related to tunneled central venouscatheter (CVC) and the most studies focused only on bloodstream infections (BSI) and were performed in developed countries. Our study aimed to provide a wide overview of ESI epidemiology in a Brazilian HD unit. We presented data from prospective surveillance carried out from March 2010 through March 2015. The overall incidence of ESI was 3.50 per 1,000 catheters-days. Risk factors for ESI were presence of diabetes and tunneled CVC implanted in femoral site (RR=1.56, 95% CI=1.35-1.89 and RR=1.62, 95% CI=1.22-1.94, p<0.05, respectively). The most frequent agents of ESI were Gram-negative (69%), mainly Serratia marcences, E coli, Proteus mirabillis, Pseudomonas aeruginosa and Klebsiela ESBL. Across the time periods, there was change in etiologic agents: Pseudomonas and ESBL agents became more frequent, while Proteus and E. coli became less frequent (p<0.05). Among Grampositive agents, 59% were resistant to methicillin. On the other hand, Gram-negative bacilli were not often multidrug-resistant. Catheter was removed in 17% due to unsuccessful treatment of ESI and it was associated with Pseudomonas (p=0.04) and BSI caused by the same agent of ESI (p=0.03). Catheter survival was shorter in ESI group (logrank=2.92, p<0.001). As conclusion, ESI rate was high on HD patients,and diabetes and femoral site of CVC were identified as risk factors for it. Catheter survival was shorter in patients who had ESI and catheter removal was associated with Pseudomonas agent and ESI plus BSI. Although Gram negative agents were more frequent, most of them were not resistant to quinolone, aminoglycoside and third generation cephalosporin. Our data suggest the routine application of topical antibiotic ointments to prevent ESI related to CVC caused by Gram negative agents.