© Reuters. FILE PHOTO: A general view of the Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, September 30, 2014. REUTERS/Tami Chappell
By Nancy Lapid
(Reuters) – Preventable bloodstream infections linked to kidney failure treatment are more common in blacks and Hispanics in the US than in whites, according to a report from the Centers for Disease Control and Prevention (CDC) released Monday.
The use of neck veins for hemodialysis administration was the most important risk factor, but not the only one, the researchers noted in the CDC’s Morbidity and Mortality Weekly Report.
Using data from multiple national databases collected between 2017 and 2020, they estimated that life-threatening Staphylococcus (or S.) aureus bloodstream infections occurred in 4,751 out of 100,000 black patients receiving hemodialysis and 4,500 out of 100,000 black patients receiving hemodialysis. Hispanics compared with 3,866 out of 100,000 white patients with late-stage kidney disease receiving these treatments.
About 40% of the infections were resistant to treatment with the antibiotic methicillin, the report found.
Patients whose kidney function falls below a certain level require a dialysis machine periodically to do the organs’ job of cleaning the blood.
The most significant risk factor for serious and life-threatening infection was the administration of dialysis through a large ‘central vein’ catheter in the neck.
Using a central venous catheter for hemodialysis conferred a six-fold increased risk of S. aureus bloodstream infection compared with using an arm port known as a fistula, the researchers found.
The highest use of central venous catheters was seen in black patients 18 to 49 years of age.
Ideally, as kidney function deteriorates and patients near the need for dialysis, doctors recommend a surgical procedure to create the fistula, with an artery connected to a vein.
Without the fistula, dialysis must be delivered through a catheter into a large central vein in the neck, which is associated with higher rates of complications, including infection, and should only be used temporarily.
Even after accounting for the use of these catheters, the risk of S. aureus bloodstream infections was still higher in Hispanics than in whites.
“Central venous catheter use was the most important risk factor, but did not fully explain the increased risk in Hispanic patients,” said study leader Dr. Shannon Novosad, team leader for Dialysis Safety at CDC’s Division of Health Care Quality Promotion.
There were also more S. aureus bloodstream infections in areas with higher poverty, overcrowding, and lower levels of education.
“In general, these are complex relationships that deserve further study,” Novosad said.
His team called for research to help minimize the use of central venous catheters, address potential barriers to the use of safer routes to hemodialysis access, and improve education for patients and healthcare providers.
“We need to focus on interventions that we know work to prevent infection, specifically in these (high-risk) groups,” Novosad said.