Hemodialyzer Reuse and Gram-Negative Bloodstream Infections

Details

• Alternative Title:
  Am J Kidney Dis
• Personal Author:
  Edens, Chris ; Wong, Jacklyn ; Lyman, Meghan ; Rizzo, Kyle ; Nguyen, Duc ; Blain, Michela ; Horwich-Scholefield, Sam ; Moulton-Meissner, Heather ; Epson, Erin ; Rosenberg, Jon ; Patel, Priti R.
• Description:
  Background
  
  Clusters of bloodstream infections caused by Burkholderia cepacia and Stenotrophomonas maltophilia are uncommon, but have been previously identified in hemodialysis centers that reprocessed dialyzers for reuse on patients. We investigated an outbreak of bloodstream infections caused by B cepacia and S maltophilia among hemodialysis patients in clinics of a dialysis organization.
  
  Study Design
  
  Outbreak investigation, including matched case-control study.
  
  Setting & Participants
  
  Hemodialysis patients treated in multiple outpatient clinics owned by a dialysis organization.
  
  Predictors
  
  Main predictors were dialyzer reuse, dialyzer model, and dialyzer reprocessing practice.
  
  Outcomes
  
  Case patients had a bloodstream infection caused by B cepacia or S maltophilia; controls were patients without infection dialyzed at the same clinic on the same day as a case; results of environmental cultures and organism typing.
  
  Results
  
  17 cases (9 B cepacia and 8 S maltophilia bloodstream infections) occurred in 5 clinics owned by the same dialysis organization. Case patients were more likely to have received hemodialysis with a dialyzer that had been used more than 6 times (matched OR, 7.03; 95% CI, 1.38–69.76) and to have been dialyzed with a specific reusable dialyzer (Model R) with sealed ends (OR, 22.87; 95% CI, 4.49–∞). No major lapses during dialyzer reprocessing were identified that could explain the outbreak. B cepacia was isolated from samples collected from a dialyzer header-cleaning machine from a clinic with cases and was indistinguishable from a patient isolate collected from the same clinic, by pulsed-field gel electrophoresis. Gram-negative bacteria were isolated from 2 reused Model R dialyzers that had undergone the facility’s reprocessing procedure.
  
  Limitations
  
  Limited statistical power and overmatching; few patient isolates and dialyzers available for testing.
  
  Conclusions
  
  This outbreak was likely caused by contamination during reprocessing of reused dialyzers. Results of this and previous investigations demonstrate that exposing patients to reused dialyzers increases the risk for bloodstream infections. To reduce infection risk, providers should consider implementing single dialyzer use whenever possible.
  
  
• Subjects:
  Aged Aged, 80 And Over Bacteremia Burkholderia Infections Case-Control Studies Decontamination Disease Outbreaks Disinfection Equipment Contamination Female Gram-Negative Bacterial Infections Humans Infection Control Kidney Failure, Chronic Kidneys, Artificial Male Middle Aged Renal Dialysis

  More +
• Source:
  Am J Kidney Dis. 69(6):726-733.
• Pubmed ID:
  27940061
• Pubmed Central ID:
  PMC5441929
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  69
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:40822b208586bf84dccd300f3c79ea9968924c4afe08bd0d952febbb270f739f
• Download URL:
  https://stacks.cdc.gov/view/cdc/45902/cdc_45902_DS1.pdf
• File Type:
  [PDF - 376.79 KB ]