Determination of nosocomial infection risk factors in patients with stage 3-4-5 chronic kidney disease

Determination of nosocomial infection risk factors in patients with stage 3- 4-5 chronic kidney disease Background and Aim: Infections in Chronic Kidney Disease (CKD) are an important cause of mortality and morbidity. Used venous catheters, urinary catheterization, dialysis treatments, tranfusion, and frequent hospitalization in CKD patients cause nosocomial infection and increase in frequency. Nosocomial infections are an important health problem due to the increase in hospital costs caused by mortality and morbidity. The aim of this study is to investigate the risk factors for nosocomial infections in CKD patients. Material and Methodology: Our study retrospectively included 87 patients diagnosed with nosocomial infection, hospitalized with stage 3-4-5 CKD diagnosis between 2014-2017 (Group 1) and 81 control patients followed up for stage 3-4-5 CKD without any finding of infection (Group 2). Cases included in the study were evaluated in terms of risk factors including laboratory parameters, use of temporary and permanent central venous catheter (CVC), urinary folley catheterization, transfusion, hemodialysis (HD) treatment and comorbid diseases, diabetus mellitus (DM), cerebrovascular accident (CVA), hypertension (HT), anemia, confusion, use of H2 receptor antagonist. Findings: In our study, infection mostly occurred in association with the catheter (40.2%) in patients who developed nosocomial infection. Catheter related bacteremia was followed by urinary track infection (UTI) (28.7%) and blood related bacteremia (27.5%), respectively, as nocosomial infections in the study. The most isolated bacterium in culture reproduction was Stafilokokkus Aureus (Staff. Aureus). In nococomial infection patients, CRP, ferritin, leukocyte, creatine, LDH, RDW and neutrophile levels and length of hospitalization were significantly higher than the control group that did not develop an infection (p<0.001). In patients with nocomial infection, albumin, calcium, hemoglobin, hematocrit levels were significantly lower than the control group with nosocomial infection (p<0.001). According to the multivariability regression analysis, use of permanent CVC in nosocomial infection patients increases the infection risk by 414.42 times, the risk of use of temporary CVC by 11.97 times, the transfusion risk by 12.421 times and the risk of use of urinary catheter by 5.002 in our study. Discussions and Conclusion: In conclusion, were determined in our study that each of use of CVC, urinary catheterization, transfusion and length of hospitalization in CKD patients can be independent risk factors in terms of developing nocosomial infection as an important reason for morbidity and mortality. We suggest identifying the risk factors and taking preventive measures, avoiding and minimizing unnecessary invasive interventions and keeping the length of hospitalization as short as possible may be efficient in reducing the frequency of developing nosocomial infection.