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CDC Promotes Campaign to Prevent Antimicrobial Resistance in Dialysis Patients

Last updated March 16, 2020

Approved by: Subramanian Malaisamy MD, MRCP (UK), FCCP (USA)

The Centers for Disease Control and Prevention (CDC) announced today, during the American Society of Nephrology conference, a campaign aimed at nephrologists to prevent antimicrobial resistance in dialysis patients.


CDC Promotes Campaign to Prevent Antimicrobial Resistance in Dialysis Patients

The Centers for Disease Control and Prevention (CDC) announced today, during the American Society of Nephrology conference, a campaign aimed at nephrologists to prevent antimicrobial resistance in dialysis patients.

Like the overall campaign to reduce antimicrobial resistance in healthcare settings, launched in March 2002, the component targeting nephrologists centers around four key strategies for preventing antimicrobial resistance in healthcare settings: 1) preventing infection, 2) diagnosing and treating infection effectively, 3) using antimicrobials wisely, and 4) preventing transmission of drug-resistant pathogens. Within these strategies are 12 specific action steps derived from evidenced-based guidelines and recommendations already developed by CDC and other organizations that clinicians can take now to prevent antimicrobial resistance in dialysis patients.

"Due to frequent hospitalizations, receipt of antibiotics, and exposure to bacterial infections at the vascular access site, dialysis patients have an ongoing risk for antimicrobial resistance," said Dr. Steve Solomon, director of CDC's healthcare quality promotion program. This campaign gives nephrologists 12 steps to protect their patients from this ongoing risk."

The action steps for nephrologists who provide care for dialysis patients include:

Action Step 1: Vaccinate Staff and Patients

Get influenza vaccine

Give influenza and pneumococcal vaccine to patients in addition to routine vaccines (e.g. hepatitis B)

Action Step 2: Get the Catheters Out

Hemodialysis

Use catheters only when essential

Maximize use of fistulas/grafts

Remove catheters when they are no longer essential

Peritoneal Dialysis

Remove/replace infected catheters

Action Step 3: Optimize Access Care

Follow established KDOQI and CDC Guidelines for access care

Use proper insertion and catheter-care protocols

Remove access device when infected

Use the correct catheter

Action Step 4: Target the Pathogen

Obtain appropriate cultures

Target empiric therapy to likely pathogens

Target definitive therapy to known pathogens

Optimize timing, regimen, dose, route, and duration

Action Step 5: Access the Experts

Consult the appropriate expert for complicated infections

Action Step 6: Use Local Data

Know your local antibiogram

Get previous microbiology results when patients transfer to your facility

Action Step 7: Know When to Say "No" to Vanco

Follow CDC guidelines for vancomycin use

Consider 1st generation cephalosporins instead of vancomycin

Action Step 8: Treat Infection, Not Contamination or Colonization

Use proper antisepsis for drawing blood cultures

Get one peripheral vein blood culture, if possible

Avoid culturing vascular catheter tips

Treat bacteremia, not the catheter tip

Action Step 9: Stop Antimicrobial Treatment

When infection is treated

When infection is not diagnosed

Action Step 10: Follow Infection Control Precautions

Use standard infection control precautions for dialysis centers

Consult local infection control experts

Action Step 11: Practice Hand Hygiene

Wash your hands or use an alcohol-based handrub

Set an example

Action Step 12: Partner With Your Patients

Educate on access care and infection control measures

Re-educate regularly

Some of the materials being developed include a slide set featuring the 12 action steps and the evidence to support them, posters, as well as a badge cards listing the 12 action steps. The campaign also features a website where nephrologist may access the 12 action steps as well as information to share with their patients.

Antimicrobial resistant infections in healthcare settings are a major threat to patient safety. Each year in the United States an estimated 2 million hospitalized people acquire infections that result in more 90,000 deaths. More than half of these infections are caused by bacteria that are resistant to at least one of the antimicrobials commonly used to treat those infections, according to CDC.

"CDC believes that this educational campaign can increase patient safety by preventing life-threatening antibiotic resistant infections," said Solomon. "In the future, CDC will announce similar action steps for clinicians who care for surgical patients, patients in long-term care facilities, and hospitalized children."

This campaign is made possible through support from the CDC Foundation http://www.cdcfoundation.org/. For more information on CDC's campaign to prevent antimicrobial resistance in healthcare settings go to www.cdc.gov/drugresistance/healthcare.

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CDC protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

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Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: March 16, 2020
Last updated: March 16, 2020