Adults on dialysis are 100 times more likely to have a Staphylococcus aureus bloodstream infection than adults in the general US population, according to a new Vital Signs report from the Centers for Disease Control and Prevention (CDC). Among the disparities identified, Black and Hispanic patients on dialysis had higher rates of staph bloodstream infections compared with White patients.
CDC investigators used data from the 2020 National Healthcare Safety Network (NHSN) and the 2017–2020 Emerging Infections Program (EIP) to describe bloodstream infections among patients receiving dialysis. To examine associations with race, ethnicity, and social determinants of health, these data were linked to the CDC/Agency for Toxic Substances and Disease Registry’s Social Vulnerability Index, US Renal Data System, and US Census.
Overall bloodstream infection rates in patients on dialysis have gone down since 2014. Based on data from 7 EIP sites in 2017–2020, however, the staph bloodstream infection rate was 100 times higher in adults receiving dialysis than not: 4248 vs 42 per 100,000 person-years, according to the report.
In 2020, 4840 dialysis facilities reported 14,822 bloodstream infections to NHSN, of which 34.2% were due to S. aureus. Of these, 37.9% were methicillin-resistant.
Use of central venous cathethers was associated with a 6.2-fold higher rate of staph infection compared with arteriovenous fistula in the NHSN cohort and a 4.3-fold higher rate of staph infection compared with arteriovenous fistula or graft in the EIP cohort.
Dialysis-related staph bloodstream infection rates were highest in Black and Hispanic patients. Adjusting for state of residence, age, sex, and vascular access type, the staph bloodstream infection risk was 1.4-fold higher in Hispanic than White patients and 1.7-fold higher in patients 18-49 years old compared with 65 years or older. After adjustment for these factors, Black patients had no higher risks.
People in areas with higher poverty, household crowding, and lower education had more staph bloodstream infections, according to the report. For example, 42.1% vs 10.4% of S. aureus bloodstream infections among patients on hemodialysis occurred in census tracts with the highest vs lowest proportion of individuals living below the poverty level.
“Dialysis-associated bloodstream infections are preventable—not inevitable,” Shannon Novosad, MD, MPH, Dialysis Safety Team Lead in CDC’s Division of Healthcare Quality Promotion stated in a news release. “Our data show that use of a central venous catheter as a vascular access type had 6 times higher risk for staph bloodstream infections when compared to the lowest-risk access, a fistula. Prevention efforts that equitably promote lower-risk vascular access types and continued use of infection prevention and control best practices can save lives.”
Catheter use, duration of use, and care may be important factors in infection, researchers suggested. CDC data confirmed that replacing catheters with arteriovenous fistulas or grafts reduces infection risk.
Rha B, See I, Dunham L, et al. Vital Signs: Health disparities in hemodialysis-associated Staphylococcus aureus bloodstream infections — United States, 2017–2020. MMWR Morb Mortal Wkly Rep. Published online February 6, 2023. doi:10.15585/mmwr.mm7206e1
Black and Hispanic patients on dialysis have higher rates of Staph bloodstream infections. News release. CDC; February 6, 2023.