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Stories of Care Podcast August 31, 2023

4 Points on Inequities in Dialysis-Related Bloodstream Infections

People from racial and ethnic minority groups are at a higher risk of end-stage kidney disease (ESKD), owing in part to the conditions that cause ESKD like diabetes and hypertension. A publication in CDC’s Morbidity and Mortality Weekly Report (MMWR) found signals linking race, ethnicity and other socioeconomic factors to hemodialysis-associated Staphylococcus aureus bloodstream infections. Shannon Novosad, MD, Team Lead of the Dialysis Safety Team in the Division of Healthcare Quality Promotion at CDC, and lead author of the MMWR paper, discussed the findings of this report in a Stories of Care podcast episode.

  1. Racial and Ethnic Differences with End-Stage Kidney Disease

    While there are likely many factors leading to people from racial and ethnic minority groups having higher prevalence of ESKD, there are also differences in treatments when kidney failure occurs. For example, Black and Hispanic patients are less likely to receive kidney transplantation. The analyses performed in the MMWR report showed that disparities exist in hemodialysis-associated Staphylococcus aureus bloodstream infections as well. Overall, adults on dialysis were 100x more likely to have S. aureus bloodstream infections than those not on dialysis, with rates clearly tied to the type of vascular access, with central venous catheter access type being the most important risk factor. However, the report also showed that Black and Hispanic hemodialysis patients had higher rates of S. aureus bloodstream infections, with Hispanic or Latino ethnicity being an independent risk factor.

  2. Socioeconomic Status Seems to Play a Role in Infection Risk

    Besides race and ethnicity, the number of infections detected were disproportionately higher in patients living in US census tracts with higher poverty, more household crowding and lower education levels. In fact, 42.1% of S. aureus bloodstream infections among patients on hemodialysis occurred in tracts in the highest quartile of population proportion living below the poverty level, versus 10.4% in tracts in the lowest poverty quartile.

    Figure 1. Percentage distribution of Staphylococcus aureus hemodialysis bloodstream infections among adult hemodialysis patients, by socioeconomic status levels of U.S. Census Bureau tracts of residence - Emerging Infections Program, United States, 2017-2020

    Source: CDC's Morbidity and Mortality Weekly Report (MMWR)

    Further research will need to be done to examine what role socioeconomic status plays and how to address those factors.

  3. Hispanic Dialysis Patients Were Most at Risk

    Vascular access type has the highest association with risk of S. aureus blood stream infections. However, after controlling for access type, Hispanic ethnicity was still associated with a 40% higher risk of infection. The reasons for this difference are not clear and require more research. However, physicians can use this information to ensure patients are getting the education and care that they need to keep themselves safe.

  4. Getting Back to IPC Basics is Essential

    The CDC’s “Core Interventions” strategy outlines nine practices to help prevent bloodstream infections in dialysis patients. These include educating staff on infection prevention and control topics, engaging patients around dialysis access types and care needed in their primary language, and providing monthly surveillance data so CDC can monitor infection rates nationally. Attention to these interventions will help decrease infections across all racial and ethnic groups.

This post provides highlights from episode eleven of the Stories of Care podcast, The Hidden Inequities of Dialysis-Related Infections. Listen to the full episode with Dr. Shannon Novosad here.

Project Firstline is a national collaborative led by the U.S. Centers for Disease Control and Prevention (CDC) to provide infection control training and education to frontline health care workers and public health personnel. The American Medical Association is proud to partner with Project Firstline, as supported through CDC-RFA-CK20-2003. CDC is an agency within the Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policies of CDC or HHS and should not be considered an endorsement by the Federal Government.


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