Nguyen Duc B, Shugart Alicia, Lines Christi, Shah Ami B, Edwards Jonathan, Pollock Daniel, Sievert Dawn, Patel Priti R
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Clin J Am Soc Nephrol. 2017 Jul 7;12(7):1139-1146. doi: 10.2215/CJN.11411116. Epub 2017 Jun 29.
Persons receiving outpatient hemodialysis are at risk for bloodstream and vascular access infections. The Centers for Disease Control and Prevention conducts surveillance for these infections through the National Healthcare Safety Network. We summarize 2014 data submitted to National Healthcare Safety Network Dialysis Event Surveillance.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Dialysis facilities report three types of dialysis events (bloodstream infections; intravenous antimicrobial starts; and pus, redness, or increased swelling at the hemodialysis vascular access site). Denominator data consist of the number of hemodialysis outpatients treated at the facility during the first 2 working days of each month. We calculated dialysis event rates stratified by vascular access type (, arteriovenous fistula, arteriovenous graft, or central venous catheter) and standardized infection ratios (comparing individual facility observed with predicted numbers of infections) for bloodstream infections. We described pathogens identified among bloodstream infections.
A total of 6005 outpatient hemodialysis facilities reported dialysis event data for 2014 to the National Healthcare Safety Network. These facilities reported 160,971 dialysis events, including 29,516 bloodstream infections, 149,722 intravenous antimicrobial starts, and 38,310 pus, redness, or increased swelling at the hemodialysis vascular access site events; 22,576 (76.5%) bloodstream infections were considered vascular access related. Most bloodstream infections (63.0%) and access-related bloodstream infections (69.8%) occurred in patients with a central venous catheter. The rate of bloodstream infections per 100 patient-months was 0.64 (0.26 for arteriovenous fistula, 0.39 for arteriovenous graft, and 2.16 for central venous catheter). Other dialysis event rates were also highest among patients with a central venous catheter. Facility bloodstream infection standardized infection ratio distribution was positively skewed with a median of 0.84. was the most commonly isolated bloodstream infection pathogen (30.6%), and 39.5% of isolates tested were resistant to methicillin.
The 2014 National Healthcare Safety Network Dialysis Event data represent nearly all United States outpatient dialysis facilities. Rates of infection and other dialysis events were highest among patients with a central venous catheter compared with other vascular access types. Surveillance data can help define the epidemiology of important infections in this patient population.
接受门诊血液透析的患者有发生血流感染和血管通路感染的风险。疾病控制与预防中心通过国家医疗安全网络对这些感染进行监测。我们总结了2014年提交至国家医疗安全网络透析事件监测的数据。
设计、地点、参与者及测量指标:透析机构报告三种类型的透析事件(血流感染;静脉使用抗菌药物起始情况;血液透析血管通路部位出现脓液、发红或肿胀加剧)。分母数据包括各月前两个工作日在该机构接受治疗的血液透析门诊患者数量。我们计算了按血管通路类型(动静脉内瘘、动静脉移植物或中心静脉导管)分层的透析事件发生率以及血流感染的标准化感染率(将各机构观察到的感染数与预测感染数进行比较)。我们描述了血流感染中鉴定出的病原体。
共有6005家门诊血液透析机构向国家医疗安全网络报告了2014年的透析事件数据。这些机构报告了160,971起透析事件,包括29,516起血流感染、149,722起静脉使用抗菌药物起始情况以及38,310起血液透析血管通路部位出现脓液、发红或肿胀加剧事件;22,576起(76.5%)血流感染被认为与血管通路相关。大多数血流感染(63.0%)和与血管通路相关的血流感染(69.8%)发生在使用中心静脉导管的患者中。每100患者月的血流感染发生率为0.64(动静脉内瘘为0.26,动静脉移植物为0.39,中心静脉导管为2.16)。其他透析事件发生率在使用中心静脉导管的患者中也最高。机构血流感染标准化感染率分布呈正偏态,中位数为0.84。金黄色葡萄球菌是最常分离出的血流感染病原体(30.6%),且测试的金黄色葡萄球菌分离株中有39.5%对甲氧西林耐药。
2014年国家医疗安全网络透析事件数据代表了几乎所有美国门诊透析机构。与其他血管通路类型相比,中心静脉导管使用者的感染率和其他透析事件发生率最高。监测数据有助于明确该患者群体中重要感染的流行病学特征。