Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities: A Report From the American Society of Nephrology and Centers for Disease Control and Prevention Antibiotic Stewardship White Paper Writing Group
2020; Elsevier BV; Volume: 77; Issue: 5 Linguagem: Inglês
10.1053/j.ajkd.2020.08.011
ISSN1523-6838
AutoresIbironke W. Apata, Sarah Kabbani, Alicia M. Neu, Tamara Kear, Erika M. C. D’Agata, D Levenson, Alan S. Kliger, Lauri A. Hicks, Priti R. Patel,
Tópico(s)Patient Satisfaction in Healthcare
ResumoAntibiotic use is necessary in the outpatient hemodialysis setting because patients receiving hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. The American Society of Nephrology and the US Centers for Disease Control and Prevention created the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients receiving maintenance hemodialysis. Based on existing evidence and the unique patient and clinical setting characteristics, the following strategies for improving antibiotic use are reviewed: expanding infection and sepsis prevention activities, standardizing blood culture collection processes, treating methicillin-susceptible Staphylococcus aureus infections with β-lactams, optimizing communication between nurses and prescribing providers, and improving data sharing across transitions of care. Collaboration among the Centers for Disease Control and Prevention; American Society of Nephrology; other professional societies such as infectious diseases, hospital medicine, and vascular surgery societies; and dialysis provider organizations can improve antibiotic use and the quality of care for patients receiving maintenance hemodialysis. Antibiotic use is necessary in the outpatient hemodialysis setting because patients receiving hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. The American Society of Nephrology and the US Centers for Disease Control and Prevention created the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients receiving maintenance hemodialysis. Based on existing evidence and the unique patient and clinical setting characteristics, the following strategies for improving antibiotic use are reviewed: expanding infection and sepsis prevention activities, standardizing blood culture collection processes, treating methicillin-susceptible Staphylococcus aureus infections with β-lactams, optimizing communication between nurses and prescribing providers, and improving data sharing across transitions of care. Collaboration among the Centers for Disease Control and Prevention; American Society of Nephrology; other professional societies such as infectious diseases, hospital medicine, and vascular surgery societies; and dialysis provider organizations can improve antibiotic use and the quality of care for patients receiving maintenance hemodialysis. The discovery of antibiotics has revolutionized the practice of medicine and saved countless lives. However, unnecessary antibiotic use contributes to the spread of antibiotic-resistant bacteria,1Tamma P.D. Avdic E. Li D.X. Dzintars K. Cosgrove S.E. Association of adverse events with antibiotic use in hospitalized patients.JAMA Intern Med. 2017; 177: 1308-1315Crossref PubMed Scopus (418) Google Scholar jeopardizes patient safety, and can lead to adverse drug events1Tamma P.D. Avdic E. Li D.X. Dzintars K. Cosgrove S.E. Association of adverse events with antibiotic use in hospitalized patients.JAMA Intern Med. 2017; 177: 1308-1315Crossref PubMed Scopus (418) Google Scholar,2Shehab N. Lovegrove M.C. Geller A.I. Rose K.O. Weidle N.J. Budnitz D.S. US emergency department visits for outpatient adverse drug events, 2013-2014.JAMA. 2016; 316: 2115-2125Crossref PubMed Scopus (482) Google Scholar such as infection with Clostridioides difficile1Tamma P.D. Avdic E. Li D.X. Dzintars K. Cosgrove S.E. Association of adverse events with antibiotic use in hospitalized patients.JAMA Intern Med. 2017; 177: 1308-1315Crossref PubMed Scopus (418) Google Scholar,3Bignardi G.E. Risk factors for Clostridium difficile infection.J Hosp Infect. 1998; 40: 1-15Abstract Full Text PDF PubMed Scopus (547) Google Scholar without the intended clinical benefit. The Centers for Disease Control and Prevention (CDC) estimates that more than 2.8 million people in the United States experience an antibiotic-resistant infection each year, and at least 35,000 people die as a result.4Centers for Disease Control and PreventionAntibiotic resistance threats in the United States, 2019.https://www.cdc.gov/drugresistance/biggest-threats.htmlGoogle Scholar Studies have suggested that kidney failure requiring dialysis is an independent risk factor for C difficile infections.5Eddi R. Malik M.N. Shakov R. Baddoura W.J. Chandran C. Debari V.A. Chronic kidney disease as a risk factor for Clostridium difficile infection.Nephrology (Carlton). 2010; 15: 471-475Crossref PubMed Scopus (58) Google Scholar,6Leekha S. Aronhalt K.C. Sloan L.M. Patel R. Orenstein R. Asymptomatic Clostridium difficile colonization in a tertiary care hospital: admission prevalence and risk factors.Am J Infect Control. 2013; 41: 390-393Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar In addition, patients receiving maintenance hemodialysis have a high prevalence of infection and/or colonization with multidrug-resistant organisms7Nguyen D.B. Shugart A. Lines C. et al.National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014.Clin J Am Soc Nephrol. 2017; 12: 1139-1146Crossref PubMed Scopus (105) Google Scholar, 8Centers for Disease Control and PreventionActive Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2015. US Dept of Health and Human Services; 2015.https://www.cdc.gov/hai/eip/pdf/2015-MRSA-Report-P.pdfGoogle Scholar, 9Centers for Disease Control Prevention (CDC)Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005.MMWR Morb Mortal Wkly Rep. 2007; 56: 197-199PubMed Google Scholar and substantial mortality resulting from infections and sepsis.10Saran R. Robinson B. Abbott K.C. et al.US Renal Data System 2018 Annual Data Report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2019; 73: A7-A8Abstract Full Text Full Text PDF PubMed Scopus (648) Google Scholar Sepsis is a life-threatening organ dysfunction due to a person's dysregulated response to infection.11Dantes R.B. Epstein L. Combatting sepsis: a public health perspective.Clin Infect Dis. 2018; 67: 1300-1302Crossref PubMed Scopus (36) Google Scholar Optimizing antibiotic use can play an important role in improving infection cure rates, preventing sepsis, reducing the unintended negative consequences of antibiotic use, and possibly reducing costs.12D'Agata E.M.C. Tran D. Bautista J. Shemin D. Grima D. Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model.Clin J Am Soc Nephrol. 2018; 13: 1389-1397Crossref PubMed Scopus (17) Google Scholar The Antibiotic Stewardship in Hemodialysis (ASHD) White Paper Writing Group is a collaboration between CDC and the American Society of Nephrology (ASN). Given nationwide interest in optimizing antibiotic use in various patient populations, the objectives of the writing group were to summarize the current literature on antibiotic use in the outpatient hemodialysis setting and highlight strategies to improve antibiotic prescribing in hemodialysis. We focused on intravenous (IV) antibiotic use because of the lack of published data for oral antibiotic use in the hemodialysis patient population in the United States. This document is not intended as guidelines or recommendations due to limited existing evidence on the topic and is intended for outpatient hemodialysis care, including home hemodialysis, but may also be relevant to inpatient hemodialysis care. The intended target audience includes kidney care providers, public health officials, patient safety officers, health care epidemiologists, and antibiotic stewardship experts. The ASHD writing group had 8 telephone call meetings over an 18-month period. Initial meetings involved discussing a framework for the white paper and developing an outline of key areas that the white paper would address. A literature search was performed concurrently using PubMed and Google Scholar to identify published articles on antibiotic use or antibiotic stewardship in dialysis settings. A summary of the literature review was presented to the group and generated discussion on study findings, data quality, and strategies to improve antibiotic prescribing. Leaders from several dialysis organizations were invited to present their antibiotic stewardship activities to the writing group. The group members wrote sections of the paper based on their areas of expertise. These sections were collated and synthesized into a cohesive manuscript. The final manuscript was reviewed and approved by writing group members and their respective organizations (ie, CDC and ASN). In the United States, there are approximately 468,000 patients receiving maintenance hemodialysis and 52,000 patients receiving peritoneal dialysis.10Saran R. Robinson B. Abbott K.C. et al.US Renal Data System 2018 Annual Data Report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2019; 73: A7-A8Abstract Full Text Full Text PDF PubMed Scopus (648) Google Scholar Ninety-eight percent of patients receiving maintenance hemodialysis receive dialysis in outpatient dialysis facilities, while the remaining 2% (~9,000 patients) receive dialysis at home.10Saran R. Robinson B. Abbott K.C. et al.US Renal Data System 2018 Annual Data Report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2019; 73: A7-A8Abstract Full Text Full Text PDF PubMed Scopus (648) Google Scholar Patients who receive maintenance hemodialysis have a high comorbidity burden from diseases such as diabetes, cardiovascular disease, stroke, and peripheral vascular disease.13Liu J. Huang Z. Gilbertson D.T. Foley R.N. Collins A.J. An improved comorbidity index for outcome analyses among dialysis patients.Kidney Int. 2010; 77: 141-151Abstract Full Text Full Text PDF PubMed Scopus (257) Google Scholar These comorbid conditions and advanced age place them at increased risk for lower extremity ischemia, ulceration, and skin and soft tissue infection.14Tognetti L. Martinelli C. Berti S. et al.Bacterial skin and soft tissue infections: review of the epidemiology, microbiology, aetiopathogenesis and treatment: a collaboration between dermatologists and infectivologists.J Eur Acad Dermatol Venereol. 2012; 26: 931-941Crossref PubMed Scopus (70) Google Scholar Patients receiving maintenance hemodialysis are also at increased risk for acquiring infections because of an impaired immune system,15Stenvinkel P. Ketteler M. Johnson R.J. et al.IL-10, IL-6, and TNF-alpha: central factors in the altered cytokine network of uremia--the good, the bad, and the ugly.Kidney Int. 2005; 67: 1216-1233Abstract Full Text Full Text PDF PubMed Scopus (749) Google Scholar frequent accessing of the bloodstream during hemodialysis, and use of hemodialysis central venous catheters (CVCs).16Fadrowski J.J. Hwang W. Frankenfield D.L. Fivush B.A. Neu A.M. Furth S.L. Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: findings from the Clinical Performance Measures and US Renal Data System projects.Clin J Am Soc Nephrol. 2006; 1: 987-992Crossref PubMed Scopus (24) Google Scholar,17Powe N.R. Jaar B. Furth S.L. Hermann J. Briggs W. Septicemia in dialysis patients: incidence, risk factors, and prognosis.Kidney Int. 1999; 55: 1081-1090Abstract Full Text Full Text PDF PubMed Scopus (388) Google Scholar Infection is the second leading cause of death in this population and sepsis accounts for most of these deaths.10Saran R. Robinson B. Abbott K.C. et al.US Renal Data System 2018 Annual Data Report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2019; 73: A7-A8Abstract Full Text Full Text PDF PubMed Scopus (648) Google Scholar Approximately 13,000 patients receiving maintenance hemodialysis died of sepsis from 2015 through 2017.10Saran R. Robinson B. Abbott K.C. et al.US Renal Data System 2018 Annual Data Report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2019; 73: A7-A8Abstract Full Text Full Text PDF PubMed Scopus (648) Google Scholar Given this high infection burden, it is not surprising that antibiotic exposure is common among patients receiving maintenance hemodialysis. At least 30% of patients receiving maintenance hemodialysis receive 1 or more doses of IV antibiotics in a given year.18Snyder G.M. Patel P.R. Kallen A.J. Strom J.A. Tucker J.K. D'Agata E.M. Antimicrobial use in outpatient hemodialysis units.Infect Control Hosp Epidemiol. 2013; 34: 349-357Crossref PubMed Scopus (44) Google Scholar,19St. Peter W.L. Solid C.A. Outpatient IV antibiotic use in the U.S. hemodialysis population, 1995 to 2007.https://render.usrds.org/2009/pres/06U_asn09_antibiotic_use.pdfGoogle Scholar Improving antibiotic prescribing to ensure that the "right antibiotic is prescribed for the right diagnosis, at the right dose and duration," while avoiding unnecessary antibiotic use, can potentially improve clinical outcomes for patients receiving maintenance hemodialysis.6Leekha S. Aronhalt K.C. Sloan L.M. Patel R. Orenstein R. Asymptomatic Clostridium difficile colonization in a tertiary care hospital: admission prevalence and risk factors.Am J Infect Control. 2013; 41: 390-393Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar Antibiotic stewardship is defined as the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients.20Centers for Disease Control and PreventionCore elements of antibiotic stewardship.https://www.cdc.gov/antibiotic-use/core-elements/index.htmlGoogle Scholar Improving antibiotic prescribing and antibiotic use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.20Centers for Disease Control and PreventionCore elements of antibiotic stewardship.https://www.cdc.gov/antibiotic-use/core-elements/index.htmlGoogle Scholar Antibiotic stewardship includes measuring how antibiotics are prescribed and implementing effective strategies to align prescribing practices with evidence-based guidelines20Centers for Disease Control and PreventionCore elements of antibiotic stewardship.https://www.cdc.gov/antibiotic-use/core-elements/index.htmlGoogle Scholar (Box 1). Improving antibiotic prescribing intersects with initiatives to improve sepsis detection and treatment such as procedures and tools to enhance identification of causative organisms to optimize antibiotic selection.11Dantes R.B. Epstein L. Combatting sepsis: a public health perspective.Clin Infect Dis. 2018; 67: 1300-1302Crossref PubMed Scopus (36) Google Scholar Interventions designed to improve antibiotic prescribing practices for hospitalized patients have been found to increase compliance with antibiotic use policies, decrease the duration of therapy, and reduce hospital length of stay.21Davey P. Marwick C.A. Scott C.L. et al.Interventions to improve antibiotic prescribing practices for hospital inpatients.Cochrane Database Syst Rev. 2017; 2: CD003543PubMed Google Scholar A systematic review and meta-analysis of 145 studies examining outcomes of antibiotic stewardship interventions in the hospital setting found that guideline-adherent empirical antibiotic therapy and de-escalation of therapy (ie, streamlining empirical treatment based on culture results)21Davey P. Marwick C.A. Scott C.L. et al.Interventions to improve antibiotic prescribing practices for hospital inpatients.Cochrane Database Syst Rev. 2017; 2: CD003543PubMed Google Scholar were associated with a reduction in mortality.22Schuts E.C. Hulscher M. Mouton J.W. et al.Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis.Lancet Infect Dis. 2016; 16: 847-856Abstract Full Text Full Text PDF PubMed Scopus (499) Google Scholar Another systematic review and meta-analysis demonstrated that antibiotic stewardship programs in hospitals reduced infection caused by C difficile and the incidence of infection and colonization with MDROs.23Baur D. Gladstone B.P. Burkert F. et al.Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.Lancet Infect Dis. 2017; 17: 990-1001Abstract Full Text Full Text PDF PubMed Scopus (485) Google ScholarBox 1Antibiotic Stewardship Terms and DescriptionsAntibiotic Stewardship•The effort to measure and improve how antibiotics are prescribed by clinicians and used by patientsPrescribing Protocols•Evidence-based protocols and standardized checklists for initiating antibiotics•Antibiotic use protocols can include clinical decision support and prompt clinicians to justify or explain the indication for an antibiotic order (accountable justification)Postprescription Review•Reviews of culture results and response to therapy after treatment initiation (antibiotic time out) to determine appropriate treatment and duration neededTracking•Measurement of antibiotic use practices to guide and evaluate interventionsAudit and Feedback•Assessment and feedback of prescribing practices back to providers to facilitate practice change•Feedback reports can include comparison of the individual prescriber practices to those of their colleagues (peer comparison) Antibiotic Stewardship•The effort to measure and improve how antibiotics are prescribed by clinicians and used by patients Prescribing Protocols•Evidence-based protocols and standardized checklists for initiating antibiotics•Antibiotic use protocols can include clinical decision support and prompt clinicians to justify or explain the indication for an antibiotic order (accountable justification) Postprescription Review•Reviews of culture results and response to therapy after treatment initiation (antibiotic time out) to determine appropriate treatment and duration needed Tracking•Measurement of antibiotic use practices to guide and evaluate interventions Audit and Feedback•Assessment and feedback of prescribing practices back to providers to facilitate practice change•Feedback reports can include comparison of the individual prescriber practices to those of their colleagues (peer comparison) CDC developed the Core Elements of Antibiotic Stewardship to provide a framework for implementing stewardship programs and activities and for monitoring and improving antibiotic use.24Sanchez G.V. Fleming-Dutra K.E. Roberts R.M. Hicks L.A. Core elements of outpatient antibiotic stewardship.MMWR Recomm Rep. 2016; 65: 1-12Crossref PubMed Scopus (392) Google Scholar,25Centers for Disease Control and PreventionCore elements of antibiotic stewardship of hospital antibiotic stewardship programs.https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.htmlGoogle Scholar The Core Elements have been developed for different health care settings, including acute care hospitals, nursing homes, and critical access hospitals, to address unique setting characteristics and patient needs.24Sanchez G.V. Fleming-Dutra K.E. Roberts R.M. Hicks L.A. Core elements of outpatient antibiotic stewardship.MMWR Recomm Rep. 2016; 65: 1-12Crossref PubMed Scopus (392) Google Scholar, 25Centers for Disease Control and PreventionCore elements of antibiotic stewardship of hospital antibiotic stewardship programs.https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.htmlGoogle Scholar, 26Centers for Disease Control and PreventionImplementation of antibiotic stewardship core elements at small and critical access hospitals.https://www.cdc.gov/antibiotic-use/core-elements/small-critical.htmlGoogle Scholar In 2016, the Core Elements were adapted for outpatient clinicians and facilities that routinely provide antibiotic treatment but these were not intended to address the outpatient hemodialysis setting.24Sanchez G.V. Fleming-Dutra K.E. Roberts R.M. Hicks L.A. Core elements of outpatient antibiotic stewardship.MMWR Recomm Rep. 2016; 65: 1-12Crossref PubMed Scopus (392) Google Scholar Outpatient hemodialysis facilities and the patient population receiving care in these facilities have unique characteristics that may be pertinent when considering antibiotic stewardship activities such as patient care characteristics and care context, facility staffing, transitions of care, and guidelines and standards (Fig 1). In the published literature there are 4 studies based on national surveillance data that describe antibiotic use in outpatient hemodialysis facilities in the United States.7Nguyen D.B. Shugart A. Lines C. et al.National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014.Clin J Am Soc Nephrol. 2017; 12: 1139-1146Crossref PubMed Scopus (105) Google Scholar,19St. Peter W.L. Solid C.A. Outpatient IV antibiotic use in the U.S. hemodialysis population, 1995 to 2007.https://render.usrds.org/2009/pres/06U_asn09_antibiotic_use.pdfGoogle Scholar,27Patel P.R. Shugart A. Mbaeyi C. et al.Dialysis Event Surveillance Report: National Healthcare Safety Network data summary, January 2007 through April 2011.Am J Infect Control. 2016; 44: 944-947Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar,28Klevens R.M. Edwards J.R. Andrus M.L. et al.Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)-data summary for 2006.Semin Dial. 2008; 21: 24-28Crossref PubMed Scopus (136) Google Scholar In addition, there are several small observational studies of a limited number of US outpatient dialysis facilities describing antibiotic use,18Snyder G.M. Patel P.R. Kallen A.J. Strom J.A. Tucker J.K. D'Agata E.M. Antimicrobial use in outpatient hemodialysis units.Infect Control Hosp Epidemiol. 2013; 34: 349-357Crossref PubMed Scopus (44) Google Scholar,29Berman S.J. Johnson E.W. Nakatsu C. Alkan M. Chen R. LeDuc J. Burden of infection in patients with end-stage renal disease requiring long-term dialysis.Clin Infect Dis. 2004; 39: 1747-1753Crossref PubMed Scopus (85) Google Scholar characterizing appropriateness of antibiotic use,18Snyder G.M. Patel P.R. Kallen A.J. Strom J.A. Tucker J.K. D'Agata E.M. Antimicrobial use in outpatient hemodialysis units.Infect Control Hosp Epidemiol. 2013; 34: 349-357Crossref PubMed Scopus (44) Google Scholar,30Snyder G.M. Patel P.R. Kallen A.J. Strom J.A. Tucker J.K. D'Agata E.M. Factors associated with the receipt of antimicrobials among chronic hemodialysis patients.Am J Infect Control. 2016; 44: 1269-1274Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar,31Hahn P.D. Figgatt M. Peritz T. Coffin S.E. Inappropriate intravenous antimicrobial starts: an antimicrobial stewardship metric for hemodialysis facilities.Infect Control Hosp Epidemiol. 2019; 40: 1178-1180Crossref PubMed Scopus (4) Google Scholar and/or assessing the effectiveness of antibiotic stewardship interventions.32D'Agata E.M.C. Lindberg C.C. Lindberg C.M. et al.The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities.Infect Control Hosp Epidemiol. 2018; 39: 1400-1405Crossref PubMed Scopus (16) Google Scholar Appropriateness of antibiotic use has also been described in the outpatient hemodialysis setting in Canada and Australia33Zvonar R. Natarajan S. Edwards C. Roth V. Assessment of vancomycin use in chronic haemodialysis patients: room for improvement.Nephrol Dial Transplant. 2008; 23: 3690-3695Crossref PubMed Scopus (24) Google Scholar,34Hui K. Nalder M. Buising K. et al.Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study.BMC Nephrol. 2017; 18: 156Crossref PubMed Scopus (21) Google Scholar and an inpatient hemodialysis unit in the United States35Green K. Schulman G. Haas D.W. Schaffner W. D'Agata E.M. Vancomycin prescribing practices in hospitalized chronic hemodialysis patients.Am J Kidney Dis. 2000; 35: 64-68Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar (Table 1).Table 1Summary of Studies on Antibiotic Prescribing in HemodialysisStudySettingObjectiveStudy TypeFindingsNational Surveillance DataSt. Peter and Solid19St. Peter W.L. Solid C.A. Outpatient IV antibiotic use in the U.S. hemodialysis population, 1995 to 2007.https://render.usrds.org/2009/pres/06U_asn09_antibiotic_use.pdfGoogle Scholar (2009)91,000-170,000 patients in all US outpatient HD facilitiesExamine IV antibiotic use trends among HD patientsRetrospective study using USRDS claims data from 1995-200730%-44% of patients had ≥1 claim for IV antibiotic dose in an outpatient dialysis setting in a given year; vancomycin was predominant antibiotic prescribedKlevens et al28Klevens R.M. Edwards J.R. Andrus M.L. et al.Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)-data summary for 2006.Semin Dial. 2008; 21: 24-28Crossref PubMed Scopus (136) Google Scholar (2008)32 US outpatient HD facilitiesReport rates of bloodstream infections, vascular access infections, and IV antibiotic startsProspective surveillance on outpatient dialysis events reported to NHSN for 2006Overall rate of IV antibiotic starts: 3.48/100 patient-months; vancomycin accounted for 73% of IV antibiotic startsPatel et al27Patel P.R. Shugart A. Mbaeyi C. et al.Dialysis Event Surveillance Report: National Healthcare Safety Network data summary, January 2007 through April 2011.Am J Infect Control. 2016; 44: 944-947Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar (2016)193 US outpatient HD facilitiesReport rates of bloodstream infections, vascular access infections, and IV antibiotic startsProspective surveillance on outpatient dialysis events reported to NHSN for 2007-2011Overall rate of IV antibiotics starts: 3.12/100 patient-months (6.28 and 1.84/100 patient-months in those with CVC and AVF, respectively); vancomycin accounted for 72% of IV antibiotic startsNguyen et al7Nguyen D.B. Shugart A. Lines C. et al.National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014.Clin J Am Soc Nephrol. 2017; 12: 1139-1146Crossref PubMed Scopus (105) Google Scholar (2017)6,005 US outpatient HD facilitiesReport rates of bloodstream infections, vascular access infections, and IV antibiotic startsProspective surveillance on outpatient dialysis events reported to NHSN for 2014Overall rate of IV antibiotic start: 3.27/100 patient-months (7.91 and 2.07/100 patient-months in those with CVC and AVF, respectively); vancomycin accounted for 76% of IV antibiotic startsWorth et al64Worth L.J. Spelman T. Holt S.G. Brett J.A. Bull A.L. Richards M.J. Epidemiology of infections and antimicrobial use in Australian haemodialysis outpatients: findings from a Victorian surveillance network, 2008-2015.J Hosp Infect. 2017; 97: 93-98Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar (2017)48 outpatient HD facilities, in Victoria, AustraliaDetermine the burden of bloodstream and local access-related infections and patterns of IV antibiotic startsProspective surveillance on outpatient dialysis events reported to VICNISS for 2008-2015IV antibiotic start rates: 3.37 and 0.73/100 patient-months in those with tunneled CVC and AVF, respectively; vancomycin accounted for 48.9% of IV antibiotic startsObservational StudiesGreen et al35Green K. Schulman G. Haas D.W. Schaffner W. D'Agata E.M. Vancomycin prescribing practices in hospitalized chronic hemodialysis patients.Am J Kidney Dis. 2000; 35: 64-68Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar (2000)103 patients receiving MHD in 1 hospital in TennesseeDetermine indications for vancomycin use and reasons for inappropriate use in hospitalized MHD patientsProspective study spanning 3 monthsHospitalized MHD patients received ≥1 dose of vancomycin significantly more often than other hospitalized patients (39% vs 5%); 20% of vancomycin doses judged inappropriate (mostly due to use for β-lactam–sensitive organisms)Berman et al29Berman S.J. Johnson E.W. Nakatsu C. Alkan M. Chen R. LeDuc J. Burden of infection in patients with end-stage renal disease requiring long-term dialysis.Clin Infect Dis. 2004; 39: 1747-1753Crossref PubMed Scopus (85) Google Scholar (2004)433 patients in 1 inpatient and 4 outpatient dialysis facilities in HawaiiExamine spectrum of infections in patients receiving maintenance dialysis (including PD and HD)Retrospective study spanning 9 yearsCefazolin accounted for highest percentage (19.8%) of antibiotic courses in maintenance dialysis patients, followed by vancomycin (18.4%)Zvonar et al33Zvonar R. Natarajan S. Edwards C. Roth V. Assessment of vancomycin use in chronic haemodialysis patients: room for improvement.Nephrol Dial Transplant. 2008; 23: 3690-3695Crossref PubMed Scopus (24) Google Scholar (2008)105 patients in 3 outpatient HD facilities in Ontario, CanadaEvaluate the appropriateness of vancomycin use in an MHD populationRetrospective study spanning 12 months88% of vancomycin doses were intitially considered appropriate but this dropped to 63% with culture and sensitivity data availability; most inappropriate vancomyc
Referência(s)