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Abstract: FR-OR002

Efficacy of Mupirocin Prophylaxis for Prevention of Bacteremia in Home Hemodialysis Patients Using Buttonhole Technique for Cannulation

Session Information

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Liu, Frank, The Rogosin Institute, New York, New York, United States
  • Dutta, Upali, The Rogosin Institute, New York, New York, United States
  • Herrera, Janice, The Rogosin Institute, New York, New York, United States
  • Mallare, Joel, The Rogosin Institute, New York, New York, United States
  • Parker, Thomas, The Rogosin Institute, New York, New York, United States
Background

Buttonhole cannulation (BC) technique is often preferred by home hemodialysis (HHD) patients but has been associated with a significant risk of bloodstream infection (BI). Despite a single center report suggesting a decrease in BI with topical mupirocin prophylaxis (MP), use of MP is not widespread, and indeed, many centers have shied away from using BC altogether. Because our patients have shown a strong preference for BC, we have continued to use BC but began mandating the use of MP in September 2013. This study is a retrospective chart review comparing the incidence of BI in patients using BC before and after we started MP.

Methods

To establish the number of treatments-at-risk for development of access-related BI, HHD billing records from January 2007 through March 2018 were reviewed to assess the total number of HHD treatments performed, as well as the access used for those treatments. Corresponding monthly QA reports were reviewed to identify episodes of BI attributable to the HD access, and confirmed by review of the underlying medical record independently by two clinicians.

Results

From January 2007 through March 2018, 133 patients performed 63,704 HHD treatments, encompassing 298.3 patient-years of observation. Of those, 50 patients performed 28,047 treatments using BC in the period prior to MP and 37 patients performed 14,702 treatments using BC in the period after MP. 21 episodes of access-related BI were observed, with 19 episodes occurring in 14 patients in the pre-MP period, and 2 episodes occurring in 2 patients in the post-MP period. Both patients who developed BI in the post-MP period admitted to non-adherence with MP at the time of BI. When analyzed by observation period, the odds ratio (OR) for BI without MP was 5 (95% confidence interval (CI) = 1.16 to 21.4; p=0.03). In an as-treated analysis, the OR for BI without MP was 21.9 (95% CI=1.3 to 361.7; p=0.03).

Conclusion

Topical mupirocin prophylaxis is effective in prevention of buttonhole cannulation-associated bloodstream infection. Buttonhole cannulation technique can be safely used for HHD if patients are adherent to a prophylaxis protocol.