Incidence of Bloodstream Infection, Bacterial etiology, Antimicrobial Susceptibility Profile and Risk Factors among patients under Hemodialysis, with Intervention Assessment in Addis Ababa, Ethiopia: A Multi-Center Prospective Cohort Study

Abstract

Abstract Background: Hemodialysis (HD) patients face high infection risk from frequent healthcare contact and biofilm-prone access. In Ethiopia, limited dialysis access and lack of multicenter data hinder understanding of infection patterns. This study integrated clinical, microbiological, and environmental surveillance across three hospitals in Addis Ababa to address these gaps. Objectives: This study aimed to assess the incidence of bloodstream infection, bacterial etiology, temporal association between environmental pathogen with incidence of infection, antimicrobial susceptibility profile, risk factors, and the impact of intervention on incidence of infection among patients undergoing HD. Methods: Multicenter prospective cohort study, conducted from May 16, 2024, to May 14, 2025, at 3 centers in Addis Ababa, Ethiopia, enrolled 168 patients (153 Chronic Kidney Disease, 15 Acute Kidney Injury) undergoing maintenance HD. Clinical data were collected via structured KoBo Toolbox questionnaires and aseptic blood cultures during bloodstream infection. Environmental swabs and water samples were taken biannually. Microbiological analysis used selective enrichment and biochemical tests. Antimicrobial susceptibility test was performed using the Kirby-Bauer disk diffusion method. Statistical analysis used IBM SPSS v27.0. Results: The study found a 16.6% BSI rate among HD patients, with 4.7% developing sepsis. Gram-negative bacteria, mainly Klebsiella spp., were predominant. Environmental contamination reached 65.2%, especially in water systems and dialysis beds, with marginal concordance (p = 0.062) to clinical isolates. MDR was observed in all clinical CoNS and environmental P. aeruginosa, with MRSA also detected among S. aureus isolates. Repeated central venous catheter exposure (AOR: 0.048, p = 0.001) and low hemoglobin (AOR: 0.635, p =0.015) were key risk factors for infection. A water pipeline replacement and improved infection control significantly reduced BSI incidence (p < 0.001). Conclusion: The study highlights a high infection burden in HD patients, with Klebsiella spp. and P. aeruginosa as dominant Gram-negative bacteria. Overlap between clinical and environmental isolates revealed the presence of strong contamination which associate with infection link. Findings support stronger infection control could improve outcomes. Keywords: Hemodialysis, Bloodstream Infection, Bacteria, Antimicrobial Resistance, Risk factor