SAN FRANCISCO—Central venous catheters are significantly associated with the development of vascular access-related bloodstream infections (VABSI) in outpatient hemodialysis (HD) patients, according to a new study presented at ID Week 2013. 

The findings suggest that improved infection surveillance by HD providers according to vascular access type may be needed, researchers reported. In addition, laboratories should provide ongoing notification and review of blood culture results for timely detection and response to VABSIs in HD patients.

“During the investigative period compared to the baseline period, outpatients with central venous catheters were 13 times more likely to develop VABSI than outpatients without central venous catheters,” said study investigator Kavita Trivedi, MD, who is with the Healthcare Associated Infections Program in the California Department of Public Health in Richmond.

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He and his colleagues noted that there has been a concerted national effort to increase the use of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) and decrease the use of central venous catheters (CVCs).  CVCs remain the most common form of access in outpatient HD centers in the U.S., however.

A Health Maintenance Organization in October 2011 noted a cluster of 11 outpatients who developed VABSIs associated with one HD provider in two counties in California during a four-month period. This prompted an investigation and the current study.

The investigators analyzed patients based on access type and blood culture data where the cluster of cases occurred. For comparison, they also looked at HD patients at a non-HMO outpatient dialysis center. The researchers compared the VABSI rates from baseline (January to June rates) to the investigative period (July to October rates). Nine HD centers were involved in this study; infection control audits were conducted at three centers.

The VABSI rates for the HD centers overall were low compared with national rates. The study, however, revealed a rise in VABSI rates during the investigative period associated with patients who had CVCs. No CVC breaches were observed.

“These findings may be relevant to other outpatient hemodialysis settings since nine hemodialysis centers were included in the investigation,” Dr. Trivedi told Renal & Urology News.  “In patients requiring chronic hemodialysis, many patients continue to have central venous catheters as their only type of vascular access, which can increase risk of developing VABSI. Nephrologists should consider establishing alternate types of vascular access more quickly. Additionally, nephrologists should assist outpatient hemodialysis centers in improving infection surveillance for timely detection and response to VABSI.”