Hemodialysis-Associated S. aureus Bloodstream Infection
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Health Disparities in Hemodialysis-Associated Staphylococcus aureus Bloodstream Infections

United States, 2017-2020

Brian Rha, MD; Isaac See, MD; Lindsay Dunham, MPH, MSDA; Preeta K. Kutty, MD; Lauren Moccia, MA; Ibironke W. Apata, MD; Jennifer Ahern, PhD; Shelley Jung, PhD; Rongxia Li, PhD; Joelle Nadle, MPH; Susan Petit, MPH; Susan M. Ray, MD; Lee H. Harrison, MD; Carmen Bernu, MPH; Ruth Lynfield, MD; Ghinwa Dumyati, MD; Marissa Tracy, MPH; William Schaffner, MD; D. Cal Ham, MD; Shelley S. Magill, MD, PhD; Erin N. O'Leary, MPH; Jeneita Bell, MD; Arjun Srinivasan, MD; L. Clifford McDonald, MD; Jonathan R. Edwards, MStat; Shannon Novosad, MD

Disclosures

Morbidity and Mortality Weekly Report. 2023;72(6):153-159. 

In This Article

Abstract and Introduction

Abstract

Introduction: Racial and ethnic minorities are disproportionately affected by end-stage kidney disease (ESKD). ESKD patients on dialysis are at increased risk for Staphylococcus aureus bloodstream infections, but racial, ethnic, and socioeconomic disparities associated with this outcome are not well described.

Methods: Surveillance data from the 2020 National Healthcare Safety Network (NHSN) and the 2017–2020 Emerging Infections Program (EIP) were used to describe bloodstream infections among patients on hemodialysis (hemodialysis patients) and were linked to population-based data sources (CDC/Agency for Toxic Substances and Disease Registry [ATSDR] Social Vulnerability Index [SVI], United States Renal Data System [USRDS], and U.S. Census Bureau) to examine associations with race, ethnicity, and social determinants of health.

Results: In 2020, 4,840 dialysis facilities reported 14,822 bloodstream infections to NHSN; 34.2% were attributable to S. aureus. Among seven EIP sites, the S. aureus bloodstream infection rate during 2017–2020 was 100 times higher among hemodialysis patients (4,248 of 100,000 person-years) than among adults not on hemodialysis (42 of 100,000 person-years). Unadjusted S. aureus bloodstream infection rates were highest among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) hemodialysis patients. Vascular access via central venous catheter was strongly associated with S. aureusbloodstream infections (NHSN: adjusted rate ratio [aRR] = 6.2; 95% CI = 5.7–6.7 versus fistula; EIP: aRR = 4.3; 95% CI = 3.9–4.8 versus fistula or graft). Adjusting for EIP site of residence, sex, and vascular access type,

*https://www.cdc.gov/healthequity/whatis/
https://www.cdc.gov/dialysis/pdfs/BSI-NHSN-2014to2019-508.pdf
§45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

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