Highlights
- •All parenteral antimicrobials administered to patients requiring chronic hemodialysis in 2 outpatient hemodialysis units over a 12-month period were quantified and assessed for appropriateness based on published guidelines.
- •A third of patients received at least 1 dose of antimicrobials, and among these, more than half received at least 1 inappropriately indicated dose.
- •Patients with a tunneled catheter access, a history of colonization or infection with a multidrug-resistant organism, and receiving hemodialysis during daytime shifts were more likely to receive antimicrobials.
- •Patients with a tunneled catheter access, receiving dialysis in unit B, and with a longer duration of hemodialysis prior to enrollment were at higher risk of receiving an inappropriately indicated antimicrobial dose.
- •Antimicrobial stewardship efforts in outpatient hemodialysis may focus on minimizing tunneled catheter use, incorporate prior history of multidrug-resistant organisms, and will likely require unit-specific practices.
Background
Antimicrobial use is common among patients receiving chronic hemodialysis (CHD) and
may represent an important antimicrobial stewardship opportunity. The objective of
this study is to characterize CHD patients at increased risk of receiving antimicrobials,
including not indicated antimicrobials.
Methods
We conducted a prospective cohort study over a 12-month period among patients receiving
CHD in 2 outpatient dialysis units. Each parenteral antimicrobial dose administered
was characterized as indicated or not indicated based on national guidelines. Patient
factors associated with receipt of antimicrobials and receipt of ≥1 inappropriate
antimicrobial dose were analyzed.
Results
A total of 89 of 278 CHD patients (32%) received ≥1 antimicrobial doses and 52 (58%)
received ≥1 inappropriately indicated dose. Patients with tunneled catheter access,
a history of colonization or infection with a multidrug-resistant organism, and receiving
CHD sessions during daytime shifts were more likely to receive antimicrobials (odds
ratio [OR], 5.16; 95% confidence interval [CI], 2.72-9.80; OR, 5.43; 95% CI, 1.84-16.06;
OR, 4.59; 95% CI, 1.20-17.52, respectively). Patients with tunneled catheter access,
receiving CHD at dialysis unit B, and with a longer duration of CHD prior to enrollment
were at higher risk of receiving an inappropriately indicated antimicrobial dose (incidence
rate ratio, 2.23; 95% CI, 1.16-4.29; incidence rate ratio, 2.67; 95% CI, 1.34-5.35;
incidence rate ratio, 1.11; 95% CI, 1.01-1.23, respectively).
Conclusions
This study of all types of antimicrobials administered in 2 outpatient dialysis units
identified several important factors to consider when developing antimicrobial stewardship
programs in this health care setting.
Key Words
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Article Info
Publication History
Published online: May 13, 2016
Footnotes
Funding/Support: Supported by the Centers for Disease Control and Prevention Division of Healthcare Quality Promotion (intergovernmental personnel agreement no. 10IPA1004108 ) and the Agency for Healthcare Research and Quality (grant no. R18HS021666 to E.M.C.D.).
Conflicts of Interest: None to report.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Identification
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© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
