Most bloodstream infections in dialysis patients continue to occur in those with central venous catheters, according to a recent analysis of data from U.S. dialysis facilities, published in the Clinical Journal of the American Society of Nephrology. The findings appear in the article “National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014.”
In their recent analysis of information gathered from the 2014 National Healthcare Safety Network, the Centers for Disease Control and Prevention’s Duc Bui Nguyen, MD, and his colleagues noted that 6,005 outpatient hemodialysis facilities reported data for a total of 160,971 dialysis events, including 29,516 bloodstream infections (BSIs); 149,722 intravenous antimicrobial starts, and 38,310 episodes of pus, redness, or increased swelling at the hemodialysis access site.
The team found that 77% of BSIs were related to accessing patients’ blood. Most—63% of BSIs and 70% of access-related BSIs—occurred in patients with a central venous catheter. BSI and other dialysis event rates were also highest among patients using central venous catheters.
Staphylococcus aureus was the most commonly isolated BSI pathogen (31%), and 40% of S. aureus isolates tested were resistant to the antibiotic methicillin.
“We now have a clearer picture of the rates and types of infections hemodialysis patients in the United States are experiencing—nearly all U.S. outpatient hemodialysis facilities are participating in CDC’s NHSN Dialysis Event surveillance,” said Nguyen. “Our findings emphasize the need for hemodialysis facilities to improve infection prevention and vascular access care practices.”
In an accompanying editorial, entitled “Infection Monitoring in Dialysis Units: A Plea for ‘Cleaner’ Data,” Dana Miskulin, MD, from Tufts University School of Medicine, and Ambreen Gul, MD, from Dialysis Clinic Inc., noted that a major problem to the available data is that event reporting is based on an honors system, with dialysis units reporting their own information.
“We make a plea to the dialysis community to ‘clean up’ the data, so that the QIP is fairer for all and to enable the full potential of these data, both for improving care now and for generating new evidence to provide future opportunities to improve care and outcomes, to be realized,” they wrote.
Study co-authors include Alicia Shugart, MA, Christi Lines, MPH, Ami Shah, MPH, Jonathan Edwards, MStat, Daniel Pollock, MD, Dawn Sievert, PhD, and Priti Patel, MD, MPH.