Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC.
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia.
Am J Transplant. 2023 May;23(5):676-681. doi: 10.1016/j.ajt.2023.04.001.
Racial and ethnic minorities are disproportionately affected by end-stage kidney disease (ESKD). ESKD patients on dialysis are at increased risk for Staphylococcus aureus bloodstream infections, but racial, ethnic, and socioeconomic disparities associated with this outcome are not well described.
Surveillance data from the 2020 National Healthcare Safety Network (NHSN) and the 2017-2020 Emerging Infections Program (EIP) were used to describe bloodstream infections among patients on hemodialysis (hemodialysis patients) and were linked to population-based data sources (CDC/Agency for Toxic Substances and Disease Registry [ATSDR] Social Vulnerability Index [SVI], United States Renal Data System [USRDS], and U.S. Census Bureau) to examine associations with race, ethnicity, and social determinants of health.
In 2020, 4,840 dialysis facilities reported 14,822 bloodstream infections to NHSN; 34.2% were attributable to S. aureus . Among seven EIP sites, the S. aureus bloodstream infection rate during 2017-2020 was 100 times higher among hemodialysis patients (4,248 of 100,000 person-years) than among adults not on hemodialysis (42 of 100,000 person-years). Unadjusted S. aureus bloodstream infection rates were highest among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) hemodialysis patients. Vascular access via central venous catheter was strongly associated with S. aureus bloodstream infections (NHSN: adjusted rate ratio [aRR] = 6.2; 95% CI = 5.7-6.7 versus fistula; EIP: aRR = 4.3; 95% CI = 3.9-4.8 versus fistula or graft). Adjusting for EIP site of residence, sex, and vascular access type, S. aureus bloodstream infection risk in EIP was highest in Hispanic patients (aRR = 1.4; 95% CI = 1.2-1.7 versus non-Hispanic White [White] patients), and patients aged 18-49 years (aRR = 1.7; 95% CI = 1.5-1.9 versus patients aged ≥65 years). Areas with higher poverty levels, crowding, and lower education levels accounted for disproportionately higher proportions of hemodialysis-associated S. aureus bloodstream infections.
Disparities exist in hemodialysis-associated S. aureus infections. Health care providers and public health professionals should prioritize prevention and optimized treatment of ESKD, identify and address barriers to lower-risk vascular access placement, and implement established best practices to prevent bloodstream infections.
少数族裔受终末期肾病（ESKD）影响较大。接受透析的 ESKD 患者感染金黄色葡萄球菌血流感染的风险增加，但与该结果相关的种族、民族和社会经济差异尚未得到充分描述。
利用 2020 年全国医疗保健安全网络（NHSN）和 2017-2020 年新兴感染计划（EIP）的监测数据，描述血液透析患者（血液透析患者）的血流感染，并与基于人群的数据来源（疾病控制与预防中心/有毒物质和疾病登记局 [ATSDR]社会脆弱性指数 [SVI]、美国肾脏数据系统 [USRDS]和美国人口普查局）联系起来，以检查种族、民族和健康社会决定因素与血液透析相关的金黄色葡萄球菌血流感染之间的关联。
2020 年，4840 家透析机构向 NHSN 报告了 14822 例血流感染；34.2%归因于金黄色葡萄球菌。在七个 EIP 地点中，2017-2020 年期间血液透析患者金黄色葡萄球菌血流感染率（每 100000 人年 4248 例）是未接受血液透析的成年人（每 100000 人年 42 例）的 100 倍。未经调整的金黄色葡萄球菌血流感染率在非西班牙裔黑人和非洲裔美国人（黑人）和西班牙裔或拉丁裔（西班牙裔）血液透析患者中最高。经中央静脉导管进行血管通路与金黄色葡萄球菌血流感染密切相关（NHSN：调整后的比率比[ARR] = 6.2；95%CI = 5.7-6.7 与瘘管相比；EIP：ARR = 4.3；95%CI = 3.9-4.8 与瘘管或移植物相比）。在调整 EIP 居住地、性别和血管通路类型后，EIP 中金黄色葡萄球菌血流感染风险最高的是西班牙裔患者（ARR = 1.4；95%CI = 1.2-1.7 与非西班牙裔白人[白人]患者相比），年龄在 18-49 岁的患者（ARR = 1.7；95%CI = 1.5-1.9 与年龄≥65 岁的患者相比）。贫困程度较高、拥挤程度较高和教育程度较低的地区占血液透析相关金黄色葡萄球菌血流感染的比例过高。
血液透析相关金黄色葡萄球菌感染存在差异。医疗保健提供者和公共卫生专业人员应优先预防和优化治疗终末期肾病，确定和解决低风险血管通路放置的障碍，并实施预防血流感染的既定最佳实践。
