Organism-specific bacteremia by hemodialysis access

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Hemodialysis (HD) access type significantly impacts infection risk.
• Limited data exists on organism-specific bacteremia rates by HD access over time.
• Understanding these rates is crucial for infection prevention strategies.

Purpose of the Study:

• To analyze organism-specific bacteremia rates across different HD access types.
• To identify trends and potential causes of bacteremia in HD patients.
• To evaluate the impact of interventions on infection rates.

Main Methods:

• Analysis of a 14-year registry database (1999-2012) of prevalent HD patients.
• Recording and expressing positive blood cultures as episodes/1,000 days by access type: AVF, AVG, CVC.
• Correlation of bacteremia rates with specific organisms and access types.

Main Results:

• Central venous catheter (CVC) access showed significantly higher bacteremia rates (1.86/1,000 days) compared to AVF (0.08) and AVG (0.31).
• A spike in coagulase-negative staphylococcus (CNS) bacteremia with CVCs (2004-2008) decreased after staff retraining.
• Pseudomonas, polymicrobial, and fungal bacteremia occurred exclusively in CVC patients; exit site infection rates were low.

Conclusions:

• HD patient bacteremia rates are strongly linked to the type of vascular access used.
• Catheter access contamination, not exit site infections, is the likely cause of high CVC-related CNS bacteremia.
• Targeted staff training can effectively reduce hemodialysis-associated infections.