Central Catheters Tied to Dialysis-Related Infections

Central venous catheter (CVC) use for hemodialysis is linked to an increased rate of bloodstream infections, according to a new study.

Researchers at the U.S. Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA) conducted an analysis of data from 6,005 outpatient hemodialysis facilities across the United States who reported incidence rates of three types of dialysis events to the CDC National Healthcare Safety Network (NHSN) - bloodstream infection (BSI); intravenous antimicrobial start; and pus, redness, or increased swelling at the vascular access site. The data included events for hemodialysis outpatients treated at each facility during the first two working days of each month.

The hemodialysis facilities reported data on a total of 160,971 dialysis events, which included 29,516 BSIs; 149,722 intravenous antimicrobial starts; and 38,310 episodes of pus, redness, or increased swelling. The researchers then calculated event rates stratified by vascular access type--arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous catheter (CVC). They then standardized infection ratios by comparing each individual facility observed with predicted numbers of infections for bloodstream infections.

The results showed that 77% of BSIs were related to accessing the patients' circulation. A majority--63% of BSIs and 70% of access-related BSIs--occurred in patients that had a CVC. Other dialysis event rates were also highest among patients using CVCs. Staphylococcus aureus was the most commonly isolated BSI pathogen (31%) among those that suffered an infection, and 40% of S. aureus isolates tested were methicillin resistant. The study was published on June 29, 2017, in the Clinical Journal of the American Society of Nephrology (CJASN).

“We now have a clearer picture of the rates and types of infections hemodialysis patients in the United States are experiencing, as nearly all US outpatient hemodialysis facilities are participating in CDC's NHSN dialysis event surveillance,” said lead author Duc Bui Nguyen, MD, of the Division of Healthcare Quality Promotion. “Our findings emphasize the need for hemodialysis facilities to improve infection prevention and vascular access care practices.”

An AVF is the most recommended access for kidney patients who must undergo dialysis, created by connecting a patient's vein and artery to form a long-lasting site through which blood can be removed and returned. Alternatively, in patients who are unsuitable for a fistula, an AVG--a plastic conduit between an artery and a vein--may be used. Some patients, however, prefer a CVC, for reasons that include inadequate preparation for dialysis, avoidance of surgery, or fear of needles (since the connection to the dialysis machine via a catheter does not require needles).

Related Links:
U.S. Centers for Disease Control and Prevention