Transcript: Black and Hispanic Patients on Dialysis Have Higher Rates of Staph Bloodstream Infections
Tuesday, February 7, 2023
Please Note: This transcript is not edited and may contain errors.
And thank you for standing by. At this time all participants are in a listen only mode until the question answer portion of today’s conference. At that time, if you would like to ask a question, please dial star zero. Excuse me, please dial star one. This call is being recorded. If you have any objections, please disconnect at this time. I would now like to turn the conference over to Benjamin Haynes. Thank you. You may begin.
Thank you, Madison. And thank you all for joining us today for the release of a new CDC Vital Signs. We are joined today by Dr. Deborah Houry CDC’s Chief Medical Officer, and Dr. Shannon Novosad, team lead for the Dialysis Safety Team in CDC’s Division of Healthcare Quality and Promotion. Please note that today’s briefing is embargoed until 1pm. Eastern when our Vital Signs is live on the CDC website. I’ll now turn the call over to Dr. Houry.
Good afternoon, everyone. Thank you for joining us today. CDC is unwavering in its commitment to equitably protect the health, safety, and security of all Americans against all threats as we begin 2023, this month, CDC Vital Signs report focuses on the threat of serious bloodstream infections and people on dialysis. More than 800,000 people in the United States live with end-stage kidney disease. 70% of these patients are treated with dialysis. And more than half of all U.S. patients who are receiving dialysis belong to a racial or ethnic minority group. CDC Vital Signs spotlights serious health threats like staph bloodstream infections in people on dialysis, and the science-based actions that can be taken to curb these threats.
The kidneys have a key role in cleaning our blood by filtering waste and toxins and eliminating excess fluid from our bodies through urine. However, certain medical conditions like diabetes and high blood pressure can lead to chronic kidney disease, which is the gradual loss of kidney function where the kidneys can no longer clean the blood effectively. This can then progress to end-stage kidney disease. That’s why it is essential for health care providers to promote practices to prevent and manage medical conditions like diabetes and high blood pressure. Unfortunately, many people lack access to such preventive care, particularly Black and Hispanic people— for a variety of reasons. This increases their risk of developing end-stage kidney disease. There are several treatments for end stage kidney disease, including kidney transplants, peritoneal dialysis and hemodialysis. Our Vital Signs report focuses on hemodialysis, a treatment to filter waste, and water from the blood hemodialysis treatment is usually done in an outpatient dialysis facility and requires the use of needles or catheters to connect a patient’s blood circulation to the dialysis machine. The machine filters toxins from the blood and then returns it to the patient. Germs like staph can get into the patient’s bloodstream via these access points. These infections can be serious or deadly, and some are resistant to some of the most common antibiotics used to treat them. In the emergency department all too often I saw patients who didn’t have access to regular dialysis treatments and had to wait each time until they were in kidney failure to get emergency dialysis. The patients will come in very sick and short of breath and after dialysis, we’re able to return home. Preventing infections among patients receiving dialysis requires a comprehensive, equitable approach across the stages of kidney disease from prevention to care. We need to encourage practices such as physical activity and healthy eating to slow the progression of chronic kidney disease and help control blood pressure and blood sugar levels. Take proven actions to prevent and control infections in dialysis facilities. Educate patients about the infection risks of the different ways blood circulation is connected to the dialysis machine or vascular access types and empower patients to ask questions. And finally, we need to reduce barriers to receiving medical care. Equitable access to health care can help us identify risks for kidney disease sooner and help people avoid dialysis altogether. Now I’ll turn it over to Dr. Shannon Novosad who will talk more about infection prevention and highlight the findings of today’s Vital Signs Report.
Thank you, Dr. Houry. Today’s Vital Signs report highlights important disparities in bloodstream infections among patients on dialysis. Dialysis treatment puts people at risk for bloodstream infection our analysis shows adults on dialysis in the U.S. were 100 times more likely to have a staph bloodstream infection than other adults in the general population. As we looked at data from 2017 to 2020, we also found that Black and Hispanic patients on dialysis had higher rates of staph bloodstream infections than White patients on dialysis. And when looking at counts of bloodstream infections, more patients on dialysis with staph bloodstream infections lived in areas with higher poverty, more household crowding, and lower education levels. For example, 42% of dialysis staph bloodstream infections occurred in areas with highest poverty levels, versus 10% in areas with lowest poverty levels. These infections are preventable and understanding these differences can help the dialysis community to focus interventions at different points along the spectrum of kidney disease care and prevention. The encouraging news is that we have seen a decrease in dialysis bloodstream infections from the increasing use of proven practices to prevent and control infections. There are three types of vascular access that are used to connect a patient’s blood circulation to the dialysis machine, fistula, graft, and central venous catheter. Vascular access type is a well-known risk factor for bloodstream infections and our data confirm this. Use of a central venous catheter as a vascular access type has six times higher risk for staph bloodstream infections compared with the, lowest risk fistula access. People with any access type can develop an infection, but fistulas have the lowest risk of infection, and central venous catheters have the highest risk of infection. As opposed to fistulas and graph, a central venous catheter involves putting a tube through the skin into a vein in the neck, chest, or groin. The end of the tube inside the body stops near the heart, and the other end remains outside of the body, exposed to germs which can adhere to the tube and move into the bloodstream. So what can be done? Removing barriers to lower-risk vascular access types for dialysis treatment is a critical step for preventing infections. It is vital to coordinate efforts among patients, nephrologists, vascular access surgeons, radiologists, nurses, nurse practitioners, and social workers to reduce the use of central venous catheters for dialysis treatment. It’s also critical to educate patients on potential treatment options, and vascular access types before they develop end-stage kidney disease. We can encourage practices to prevent and slow the progression of chronic kidney disease, particularly in areas of lower socioeconomic status. We can apply proven practices to prevent and control infections in all U.S. dialysis facilities. Finally, we can work toward reducing barriers for patients receiving medical care by offering transportation assistance, insurance coverage, expertise, and social work services. It is important that all these proven actions include patient education materials that are culturally appropriate and in the patient’s preferred language. This may be especially relevant for Hispanic patients, given the higher staph bloodstream infection risks observed in Hispanic people. I do want to recognize that many dialysis providers are making these efforts and CDC is committed to supporting them. And now I will turn it back over to Dr. Houry.
Wait, thanks so much. I believe Benjamin is going to open it up for media at this time.
Thank you, Madison, we are ready to open up for questions.
Thank you. If you would like to ask a question, please dial star one. unmute your phone and record your name clearly. If you would like to withdraw your question, please dial star two. Our first question comes from Spencer Kimball from CNBC. Spencer, your line is open.
Hi, thank you. I might have missed the figure in the report. But can you say how much higher was the rate of staph infections among Black Americans compared to White Americans? And then, the report also mentioned infections are a leading cause of illness and death in dialysis patients. Do you have any data you can provide on that? And how much you have infections declined since 2014. Thank you.
This is Dr. Novosad. And for the first question, I can give you the rates here for the different groups. So for Hispanic patients, the rate was 4,500 per 100,000 of patients on hemodialysis per year. And then for the non-Hispanic white patients, it was 3,866 with the same number on the bottom and the for non-Hispanic black it was 4,751. And then overall for Hispanic patients after adjusting for other factors, we found a 40% higher risk of bloodstream infections for that group. And then I’m sorry, could you repeat your second question for me?
Yeah, sorry, what? On Black Americans is around a percentage, a percentage of how much higher the risk is?
Yeah, we can get you that number.
It was just like my other questions were, how much illness and death do bloodstream infections cause in dialysis patients? And then the report mentioned that these infections have declined since 2014. Is there any data on how much they have dropped?
Yes, so we have the data for between 2014 and 2019 overall bloodstream infections in dialysis patients decreased 40%during that time. And then, in regards to the question regarding, you know, hospitalizations, and deaths in the patients with bloodstream infections, they actually are a substantial burden for these patients their infections overall, are thought to be the second leading cause of death in dialysis patients that again, that’s all infections, not just bloodstream infections, and then for hospitalizations are also one of the leading causes of hospitalizations for these patients. Thank you. Next question, please.
Our next question comes from Joyce Frieden from Med Scape. Your line is open.
Great. Hi, thanks for taking my question. You mentioned that there were clinical considerations in terms of which type of vascular asked access people get. So I wondered if you could elaborate on that a little bit. And also talk about the other barriers to getting the least infectious type of access.
Hi, this is Dr. Novosad. There are a number of different considerations that must be taken into account for an individual patient to decide, you know exactly what kind of access, you know they should have. They include, you know, their age, how long it is thought, they’re going to be on dialysis. And then there’s also important considerations regarding what their blood vessels are like in their body and whether or not a fistula or graft could be successfully placed for that patient. And there’s also kind of just for all patients, you know, vascular access, particularly a fistula and graph does require, you know, more advanced planning and appointments with different kinds of healthcare providers than just placing a central venous catheter.
And, and is that what you meant when you were talking about the barriers that people were having, like, even if they were clinically eligible, say for fistula access?
I think that could be some of the barriers that patients are encountering, it could be, you know, for a particular barrier, they just may not be eligible for a fistula or graft, you know, because of their blood vessels or anatomy, like I mentioned, but in general, we were also referring more to barriers that have to do with access to care, or even knowing about their chronic kidney disease far enough ahead of time to, you know, really plan for these lower risk types of vascular access. Thank you. Next question, please.
Thank you. And just as a reminder, if you would like to ask a question, please dial star one. Our next question comes from Gary Evans from Relias Media. Your line is open.
Yeah, thank you. Oh, can you hear me? Yeah. Oh, good. Okay, would decline, pull 14 to 2019. That was similar for hospital infections in general. And then the gains were all wiped out in 2020 20, with the pandemic, and 2021 as well. So there’s a link up there, those drops in infection will be lost into the pandemic. When you look at that data. Do you have any data?
So we didn’t include that data in this analysis here, but we have done some preliminary analyses looking at overall bloodstream infections, in patients on dialysis, using you know, one of the data sources that we use in this report. And among dialysis patients we did not find increases, you know, during the COVID pandemic, which may have been seen in other healthcare settings. So now, we still need to, you know, analyze the data more and continue to follow it. But as of now, we don’t think that we lost headway in preventing bloodstream infections during the COVID pandemic in dialysis patients. And this is how I would I
We would just add, as you know, during the COVID pandemic, we did see decreases in preventive care, particularly initially. And I think if we’re talking about disparities and other concerns that would be to make sure that patients get back to their primary care physician and get screened for high blood pressure and diabetes, and other conditions that can lead to this chronic kidney disease. Because our concern is, if that’s missed, they can go on to have end stage kidney disease. So this is a critical time for patients if they haven’t seen a health care provider to make sure that they do so.
Okay, a quick follow up. Dr. Novosad, can you say anything about resistant infections have a good level of MRSA or perhaps other types of organisms, or any gram negatives?
Yes, specifically, in this analysis, we did look at the percent of, of these staph infections that were due to MRSA, and that was about 40% of the staph infections were due to MRSA. Overall, gram negative infections are still an important also an important cause of bloodstream infections, and we think they probably account for about 12% of overall bloodstream infections in dialysis patients. Okay, thank you.
And we are showing no further questions at this time.
Thank you, Madison. If there are no further questions, I’ll turn the call back over to Dr. Houry to close this out.
Well, thank you, I greatly appreciate everyone’s time and joining us this afternoon. This Vital Signs report identifies many of the steps that can be taken to reduce the rates of potentially fatal bloodstream infections associated with dialysis treatments, disproportionately impacting people with racial and ethnic minority groups. It is essential, we educate people within these groups about treatment options, and infection risks of different dialysis vascular access types. By addressing racial, ethnic and socioeconomic disparities contributing to dialysis bloodstream infections, we can prevent infections and save lives. Thank you.
Thank you, Dr. Houry. And thank you all for joining us today. Again, today’s briefing is embargoed until 1pm. Eastern when Vital science goes live on our website. For follow up questions please call the main CDC line at 404-639-3286 or you can email email@example.com Thank you.
That concludes today’s conference. Thank you for participating you may disconnect at this time.
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