Surveillance of Hemodialysis Events: A Prospective Multicenter Study, First Report from Turkey

Abstract Background With the increasing numbers of hemodialysis (HD) patients, HD-related infections are becoming common. However, there is neither a surveillance system nor a study to reveal the HD-related infection rates in Turkey. We aimed to investigate the infection rate among HD outpatients and current status in our country. Methods A multicenter prospective surveillance system is performed to investigate the infection incidence among HD patients. We implemented a central database for data collection with a web interface compatible with mobile devices. CDC National Healthcare Safety Network (NHSN) dialysis event (DE) protocol is adopted for definitions and reporting. Dialysis event rates are calculated for each vascular access type and given as per 100 patient months. Results During April 2016–April 2017, 9 centers reported data to the system. A total of 145 DEs reported in 5718 patient-months, and the overall DE rate was 2.53 per 100 patient-months during the surveillance period. Data for each event type and vascular access type are given in Figure 1. Most frequently isolated microorganisms from blood cultures are given in Table 1. DEs were significantly more common in patients with catheters compared with patients with fistulas (P < 0.0001). DE rate was significantly lower in patients educated about the care of their vascular access site (P < 0.0001). Outcomes of DEs were hospitalization (84%), loss of vascular access (17%), and death (8%). Conclusion This first surveillance study on DE in Turkey revealed the current status of DE in HD patients, and will guide to generate a national surveillance system for raising the awareness on the issue and maintaining much lower DE rates. Figure 1. Table 1: Isolated microorganisms Microorganism Fistula Catheter Total, n (%) Staphylococcus coagulase-negative 3 7 10 (27) Staphylococcus aureus 2 5 7 (18.9) Escherichia coli 1 5 6 (16.2) Klebsiella pneumonia 1 3 4 (10.8) Enterobacter spp. 1 2 3 (8.1) Pseudomonas aeruginosa 0 3 3 (8.1) Enterococcus faecalis 0 2 2 (5.4) Candida spp. 0 1 1 (2.7) Enterococcus faecium 1 0 1 (2.7) Total 9 28 37 (100) Disclosures All authors: No reported disclosures.