Catheter-Related Bloodstream Infection Complicated by Infective Endocarditis in a Patient Undergoing Hemodialysis
DOI:
https://doi.org/10.29303/jk.v15i1.8685Kata Kunci:
CRBSI, ESKD, Infective Endocarditis, Hemodialysis, Acinetobacter baumanniiAbstrak
Background: End-stadium kidney disease (ESKD) necessitates long-term hemodialysis, wherein the utilization of central venous catheters (CVCs) heightens the risk of catheter-related bloodstream infections (CRBSIs). The persistence of bacteremia has the potential to progress into infective endocarditis (IE), which is associated with significant morbidity and mortality.
Case Presentation: We present a case of a 30-year-old female with a medical history of chronic kidney disease (CKD) stadium 5 undergoing regular hemodialysis. She presented with systemic symptoms including fever, chills, joint pain, and localized discomfort at the catheter insertion site. Notably, her clinical history included the placement of a jugular CVC followed by the insertion of a tunneled catheter prior to the creation of an arteriovenous shunt. Laboratory evaluations demonstrated severe anemia, leukocytosis, and advanced renal impairment. Blood cultures yielded multidrug-resistant Acinetobacter baumannii, with sensitivity limited to imipenem. Echocardiographic assessment revealed significant tricuspid regurgitation with a vegetation measuring 11 × 16 mm, indicative of right-sided IE. The patient was diagnosed with ESKD, CRBSI, and IE, and subsequently managed with hemodialysis, broad-spectrum antibiotic therapy (including meropenem), supportive measures, and a plan for catheter removal.
Conclusion: This case underscores the complex interrelationships between CKD, CRBSI, and IE in hemodialysis patients with prolonged catheter utilization. Timely recognition and intervention, including appropriate antibiotic therapy tailored to culture sensitivities and vigilant vascular access management, are essential to mitigate morbidity and mortality associated with these conditions.
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Hak Cipta (c) 2026 Tazkiyah Arafah Amatullah, I Gede Yasa Asmara
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