Abstract: TH-PO892

National Healthcare Safety Network Dialysis Bloodstream Infection Data—2016

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Nguyen, Duc B., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Moon, Shunte, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Guffey, Taylor, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Lines, Christi, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Rvindhran, Preeti, Centers for Disese Control and Prevention, Atlanta, Georgia, United States
  • Edwards, Jonathan, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Patel, Priti R., Centers for Disese Control and Prevention, Atlanta, Georgia, United States
Background

Among hemodialysis (HD) patients, bloodstream infections (BSIs) are often severe adverse events. The Centers for Disease Control and Prevention (CDC) conducts surveillance for these events through the National Healthcare Safety Network (NHSN). We summarized 2016 BSI data submitted to NHSN Dialysis Event Surveillance and compared to data from previous years.

Methods

A BSI is defined in the NHSN surveillance protocol as a positive blood culture collected in an HD outpatient or within 1 calendar day of a hospitalization. Access-related BSIs (ARBSI) are positive blood cultures with either a suspected vascular access source or uncertain source as indicated on the event reporting form. Denominator data consist of the number of HD outpatients treated at the facility during the first two working days of each month. BSI rates were stratified by vascular access type (e.g., arteriovenous fistula [AVF], arteriovenous graft [AVG], central venous catheter [CVC]). We compared BSI rates during 2014–2016 controlling for access type using generalized linear models.

Results

In 2016, 6,437 outpatient HD facilities reported 151,943 dialysis events to NHSN, including 27,108 BSIs, of which 20,375 (75.2%) were ARBSI. Most BSIs (62.7%) and ARBSIs (70.2%) occurred in patients with a CVC. Hospitalization and death associated with events occurred among 52.9% and 2.8% of BSI, respectively. The rate of BSI per 100 patient-months was 0.56 (0.22 for AVF, 0.37 for AVG and 1.84 for CVC) with 25th and 75th percentile of 0.2 and 0.79, respectively. During 2014–2016, the yearly reduction in rates controlling for access type was 7.1% (95% confidence interval [CI]: 5.9–8.2) for BSI and 8.3% (95% CI: 7.0–9.6) for ARBSI.

Conclusion

Rates of BSI were highest among patients with CVC. BSI and ARBSI appeared to have decreased during 2014–2016, possibly due to nationwide prevention efforts. Our results suggest that even though progress towards BSI prevention has been achieved, opportunities exist to reduce rates of BSIs and ARBSIs among HD patients.

Pooled mean rate per 100 patient-months, stratified by access type
 201420152016
BSI0.640.600.56
AVF
AVG
CVC
0.26
0.39
2.16
0.24
0.39
2.02
0.22
0.37
1.86
ARBSI0.490.450.42
AVF
AVG
CVC
0.16
0.27
1.83
0.13
0.26
1.68
0.13
0.25
1.56

Funding

  • Other U.S. Government Support