Infection Rates Among Dialysis Patients Declining

The positive trend is more pronounced among established patients than those who recently started dialysis.
The positive trend is more pronounced among established patients than those who recently started dialysis.

BOSTON—Overall infection rates among dialysis patients have decreased over time, but much more so in established than new patients, “demonstrating how the period after initiation is still fraught with danger from infections,” researchers reported at the National Kidney Foundation 2016 Spring Clinical Meetings.

Using 2004–2013 data from the Centers for Medicare & Medicare Services end-stage renal disease database, James B. Wetmore, MD, of Hennepin County Medical Center in Minneapolis, Minn., and colleagues from the Peer Kidney Care Initiative found that the overall infection rate among patients who recently initiated dialysis decreased significantly by 6% (from 63 to 59 per 100 patient-years). The overall rate among established patients decreased significantly by 23% (from 48 to 37 per 100 patient-years), the researchers reported in a poster presentation.

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Access infection decreased significantly by 46% (from 14.1 to 7.6 per 100 patient-years). Dr. Wetmore's group observed a seasonal pattern, with rates 19% higher on average in the 3rd quarter versus the 4th quarter.

Rates of bacteremia/sepsis, however, rose 33% during the study period, partially offsetting the decrease in access infections.

Results also demonstrated that pneumonia and influenza rates among established patients have been relatively stable, but with pronounced seasonal variation, the researchers reported.

“The good news for the dialysis community is that overall infection rates appear to be slowly decreasing over time, although more for prevalent, or established, patients than for ones who have recently started dialysis,” Dr Wetmore told Renal & Urology News. “Pneumonia and influenza seem not to have decreased over time, however, and the winter months have significantly higher rates of these infections than the summer months.”

A particular infection that deserves close monitoring is colitis caused by Clostridium difficile, which causes severe colon infections and occurs when patients have been exposed to other antibiotics for other types of infections, Dr Wetmore said. “We will have to see whether this trend continues and whether antibiotic stewardship efforts decrease rates of C. diff infections.”

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