Catheter-related bloodstream infection (CRBSI) is a major complication of temporary, non-tunneled hemodialysis (HD) catheters, yet contemporary incidence data are scarce. In a 12-month prospective cohort (1 February 2023 – 31 January 2024), we followed all adult inpatients who received a non-tunneled dual-lumen HD catheter until device removal. At removal, we obtained paired blood cultures from each lumen, a peripheral culture and a semi-quantitative tip culture. CRBSI was defined by the concordant growth of the same organism in ≥ 3 of the 4 cultures. The primary outcome was the incidence of CRBSI per 1,000 catheter-days; secondary outcomes included colonization rate and pathogen distribution. Ninety-four patients (50% male; mean age, 67.6 ± 14.1 years) carried 108 catheters, resulting in 1,550 catheter-days. Right femoral insertion predominated (74%); median dwell time was 12 days, and 39% of catheters remained in situ >14 days. Systemic antibiotics were given for 55 catheters (51%) within the preceding 14 days. Cultures were sterile for 67 catheters (62.0%) and showed colonization without bacteremia in 30 (27.8 %; 19.4/1000 catheter-days, 95% CI 13-28). Six catheters (5.6%) met CRBSI criteria, giving an incidence of 3.87/1000 catheter-days (95% CI 1.4-8.4). All CRBSI episodes occurred within 14 days of insertion. Isolates were Pseudomonas aeruginosa (n = 3), Enterococcus faecalis (n = 2) and Klebsiella oxytoca (n = 1). Only 5 of 21 catheters (24%) removed for presumed infection were confirmed CRBSI; no infection-related deaths occurred. CRBSI incidence aligns with international benchmarks and is front-loaded to the first two weeks of catheter use. These data support expedited conversion to definitive access to minimize early exposure, rigorous diagnostic bundles to avoid unnecessary exchanges and empirical regimens with gram-negative activity tailored to local epidemiology.
Figueiredo et al. (Wed,) studied this question.