Clinical Characteristics and Microbiology of Bloodstream Infections in Hemodialysis-Dependent Patients: A Multicenter Retrospective Study from Five Hemodialysis Centers in Saudi Arabia

Abstract Patients receiving hemodialysis are at high risk for bloodstream infections (BSIs), particularly those with central venous catheters (CVCs). Regional variation in microbial patterns has been reported, with studies from Saudi Arabia suggesting a higher prevalence of gram-negative pathogens compared with Western cohorts. This study aimed to describe the clinical characteristics and microbiology of BSIs among hemodialysis-dependent patients treated within the Ministry of National Guard Health Affairs in Saudi Arabia and to compare findings with international data. We conducted a retrospective, multicenter study across five hemodialysis centers in Saudi Arabia over a 5-year period (January 2019–December 2023). Adult patients (≥15 years) on maintenance hemodialysis with confirmed BSI based on positive central or peripheral blood cultures were included. Demographic data (including age and body mass index [BMI]), comorbidities, vascular access type, microbiological isolates, and clinical outcomes were evaluated. A total of 437 hemodialysis patients with positive blood cultures were identified, yielding 709 microbial isolates. The study population had a median age of 58 years, and obesity was prevalent (41.7% with BMI >30 kg/m2). CVCs were present in 92.7% of BSI episodes, while arteriovenous fistulas or grafts accounted for 7.3%. Hypertension (88%) and diabetes mellitus (60%) were the most common comorbidities. Overall, gram-negative organisms predominated (51.8%), followed by gram-positive organisms (48.2%). Staphylococcus aureus was the most frequent gram-positive pathogen, while Enterobacter cloacae and Klebsiella pneumoniae were the leading gram-negative isolates. Catheter removal was performed in 57.3% of cases, while catheter salvage was successfully attempted in 42.7%. The 4-week mortality was remarkably low (1.14%). BSIs in hemodialysis patients are predominantly catheter-associated and demonstrate a substantial gram-negative burden, differing from traditional Western patterns. High obesity rates and prolonged CVC reliance underscore the need for region-specific prevention strategies, including early permanent access creation, strict catheter management, and antimicrobial stewardship. The favorable mortality rate highlights the effectiveness of current early detection and management protocols.