Oct 24, 2017

Curbing Infections | Kidney Week 2017

Joel Topf, M.D. interviews Sumi J. Sun, one of the lead researchers on new applied clinical research presented at Kidney Week 2017

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Abstract

TITLE: Sustained Low Central Venous Catheter-Related Bloodstream Infection Rates in HD Patients with an Antibiotic Look over a 3-year Period

AUTHORS: Sumi J. Sun, M.D., Norma Gomez, M.D. Fang Yang, M.D., Graham E. Abra, M.D., Brigitte Schiller, M.D.

INSTITUTIONS: Satellite Healthcare clinics in San Jose, CA, United States; Stanford University, Palo Alto, CA, United States

BACKGROUND: CVCs are associated with catheter-related bloodstream infection (BSI) resulting in increased morbidity and mortality. Following our report of significantly reduced infection when 320 mg/mL gentamicin in 4 percent citrate is used as the CVC locking solution (Moran AJKD 2012), this has remained the standard care in patients dialyzing with a CVC, unless the physician ordered otherwise. The infection rates were monitored through an internal QC program developed for National Healthcare Safety Network (NHSN) reporting.

METHODS: This study evaluated NHSN data with self-reported infection rates from January 2014 to December 2016 in a nonprofit dialysis provider with a total of 57 free-standing dialysis facilities serving more than 5000 HD patients. BSI was reported according to NHSN criteria. Data were audited through comparison to an internal infection control report and discrepancies reconciled prior to the final NHSN submission. Blood cultures were mandated before any antibiotic administration for suspected BSI, and 85 percent were sent to one internal lab (Ascend).

RESULTS: The rate of catheter-related bloodstream infection over the three years was 1.00 episodes/100 patient months, 54 percent lower than the national average of 2.16 for CVC-related BSI (2014 NHSN BSI Pooled Mean Rate/100 patient months). Monthly BSI rates showed minor fluctuations, however none exceeded the national average in any given month.

CONCLUSION: Gentamicin 320mg/mL in 4 percent sodium citrate as a routine catheter lock demonstrated sustained low CVC related BSI rates in HD patients, with approximately half the infection rate compared with the national average. Gentamicin-citrate lock should be considered the standard of care in patients with CVC access.