Study uncovers disparity in hemodialysis-associated S. aureus infections
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Adults on dialysis for end-stage kidney disease are 100 times more likely to have a Staphylococcus aureus bloodstream infection than those not on dialysis, according to a new report, which uncovered disparities in the rates of infection.
During a recent 4-year period, Hispanic ethnicity was associated with a 40% higher risk for dialysis-related S. aureus bloodstream infection compared with being white, researchers reported.
A higher crude rate of infection among Black patients did not remain statistically significant after adjusting for other variables, “suggesting the higher unadjusted rate might be mediated by other factors,” the authors wrote.
“It’s been well established that there are racial, ethnic, and other sociodemographic disparities associated with developing end-stage kidney disease,” Shannon Novosad, MD, MPH, medical officer in the CDC’s Division of Healthcare Quality Promotion and team lead for the Dialysis Safety Team, told Healio.
“We found what was really lacking [were] more detailed descriptions of how these different factors — racial, ethnic, sociodemographic factors — were actually associated with infections, and particularly bloodstream infections, which we know are very common and in this population of patients,” Novosad said. “So, that's what really prompted us to take a closer look with the available CDC data to get a better answer on that.”
Novosad and colleagues used surveillance data from the 2020 National Healthcare Safety Network (NHSN) and the 2017-2020 Emerging Infections Program (EIP) to assess bloodstream infections among patients on hemodialysis linked to population-based data sources and examine associations with race, ethnicity and social determinants of health.
In total, 4,840 dialysis facilities reported 14,822 bloodstream infections to NHSN in 2020, 34.2% of which were attributable to S. aureus.
Data from seven EIP sites showed that the S. aureus bloodstream infection rate between 2017 and 2020 was 100 times higher among patients on hemodialysis (4,248 of 100,000 person-years) than among adults not on hemodialysis (42 of 100,000 person-years).
Data from both NHSN and EIP systems also showed that vascular access via central venous catheter was strongly associated with S. aureus bloodstream infections (NHSN adjusted RR = 6.2; 95% CI, 5.7-6.7 vs. fistula; EIP aRR = 4.3; 95% CI, 3.9-4.8 vs. fistula or graft).
According to the study, S. aureus bloodstream infection rates were notably higher among Hispanic patients (aRR = 1.4; 95% CI = 1.2-1.7 vs. non-Hispanic white patients), and patients 18 to 49 years old (aRR = 1.7; 95% CI = 1.5-1.9 vs. patients aged 65 years and older).
Outside of these groups, the study found higher rates of S. aureus bloodstream infections among people in areas with higher poverty levels, household crowding and those with lower education.
Novosad said that previous data hinted at these disparities and thought those data were generally from smaller studies that looked at only specific subsets of patients, adding that that this report was one of the first times researchers were able to look nationally with such comprehensive data for these findings.
She said that next steps to lessen these disparities will include using known interventions to prevent infections and applying them in a more targeted way among these groups of patients who have a particularly high risk.
“There are groups of patients out there on dialysis who are at higher risk of getting infections, and we know how to prevent infections for dialysis patients,” Novosad said. “We need to ensure that these proven practices will be applied equitably across all of these groups.”
References:
- Black and Hispanic patients on dialysis have higher rates of staph blood stream infection. https://www.cdc.gov/media/releases/2023/s0206-vs-staph-infection.html. Published Feb. 6, 2023. Accessed Feb. 6, 2023.
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