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End stage renal disease (ESRD) patients have an increased risk of morbidity and mortality due to infections, as these patients have multiple comorbidities, may suffer frommalnutrition, and have profound alterations in their immune system. To determine the prevalence of healthcare associated infections (HCAIs) and their microbial etiology among ESRD patients undergoing renal replacement therapy (RRT).A multicenter, retrospective study of patients on RRT was conducted from June 2019 to December 2019 at two hospitals, including university of Malaya medical centre (UMMC) and hospital Serdang. ESRD patients with minimum of 6 months on RRT were included in this study, while pregnant patients and patients below the age of 18 years were excluded. To confirm the diagnosis of HCAI, patient had to fulfil at least one of the following criteria: 1) attended a hospital, received intravenous therapy, wound care or specialized nursing care in 30 days before the infection or 2) was hospitalized in an acute care hospital for 2 or more days in the previous 90 days. A data collection form was used to retrieve all sociodemographic and clinical data. To reduce the risk of selection bias, all patients were randomly selected using an online tool; research randomizer, which utilizes total number of patients and the sample size to generate random numbers. The period prevalence showing the proportion of patients that acquired HCAI since the initiation of dialysis till 2019, was calculated using a formula stated by European patients' academy (EUPATI). Total of 670 records were examined, out of which 400 patients were selected based on the inclusion criteria. There were 174 patientswith at least one episode of HCAI,hencethe period prevalence was found to be 43.5%. Catheter related blood stream infection (CRBSI) was the most common infection and occurred in 64 (36.8%) patients, while peritonitis and pneumonia were identified in 44 (25.8%) and 36 (21.2%) patients, respectively. Out of 382 total pathogens identified through microbial culture, 204 (53.4%) were gram-positive and 162 (42.4%) were gramnegative. Among the gram-positive organisms,Staphylococcus aureuswas identified in 90 (23.5%) patients, while Staphylococcus epidermidis and Streptococcus spp. were seen in 42 (10.9%) and 24 (6.28%) patients, respectively. Klebsiella pneumonia, which was found in 36 (9.42%) patients, was most frequently identified gram-negative organism. Moreover, Candida spp. were the only fungal organisms found in this study. Both methicillin sensitive S. aureus(MSSA) and methicillin resistant S. aureus(MRSA) showed statistically significant associations (p = <0.05) with CRBSI, while MSSA and klebsiella pneumonia showed similar associations (p = <0.05) with pneumonia. High prevalence of HCAIs was found among ESRD patients undergoing RRT, which is quite alarming. Furthermore, broad range of pathogens were also identified to be associated with these infections. [ABSTRACT FROM AUTHOR]