A study from the US Centers for Disease Control and Prevention (CDC) has found that black and Hispanic patients who are undergoing dialysis are at much higher risk of Staphylococcus aureus bloodstream infections than white people who are on dialysis. As per the data, rates of Staphylococcus aureus bloodstream infections among hemodialysis patients had been around 40 percent greater in Hispanic patients as compared to non-Hispanic white patients. The managing director of the CDC National Center for Emerging and Zoonotic Infectious Diseases in Atlanta, Shannon Novosad has said there is a need for an inclusive approach to protective care that identifies racial, socioeconomic, and ethnic disparities. Experts have said that healthcare providers and public health experts need to prioritize prevention and optimized treatment of end-stage kidney disease (ESKD) and need to identify and address barriers to reduced-risk vascular access placement. They have said that health professionals should try and use recognized best practices to avert such bloodstream infections. Novosad and other authors of the study have stated that the United States accounts for over 800000 patients who suffer from end-stage kidney disease (ESKD) and around 70 percent of them are given dialysis treatment. As per the study data, around 89 percent of people who are on dialysis are given hemodialysis, while only 11 percent of them are given peritoneal dialysis. The findings of the study have revealed that patients who were on dialysis from 2017 to 2020 were found with a 100 times more risk of developing Staphylococcus aureus bloodstream infections as compared to people who were not given hemodialysis.
The authors of the study have said that the incidence of ESKD is four times greater among people from the Black community and more than two times greater in Hispanic people as compared to white persons. They have stated that these are inequalities that are considered to be contributing at least in part to underlying health issues such as high blood pressure and diabetes and also, gaps in pre-ESKD nephrology treatment and receipt of ESKD remedies exist for these same groups, as well as among those who have low incomes and less or no insurance coverage. As per the data, people from the Black community account for 33 percent of total patients who are on dialysis in the United States while these people account for only 12 percent of the U.S. population. The study has found that Staphylococcus aureus bloodstream infections are a major cause of death among patients who receive hemodialysis. Around 40 percent of Staphylococcus aureus bloodstream infections fall under the methicillin-resistant variety (MRSA). Health experts have said that the form of hemodialysis as well has a vital role to play in the risk of infection. As per the findings of the study, the risk of infection is greatest for central venous catheters (CVCs), slightly lower for grafts, and the risk of bloodstream infections is the lowest for fistulas. However, the team of experts led by Novosad has further said that though increased rates have been seen in both invasive MRSA infections in Black dialysis patients and hospitalizations for infections linked to dialysis in adult Black patients and elderly Hispanic patients, the link in infections related to hemodialysis, race and ethnicity, and social factors of health is mostly unclear.
This area was further explored by the team of experts who observed infection incidents at around 7097 dialysis centers in 2020. 4840 facilities identified nearly 14822 cases of bloodstream infections during the study. 34.2 percent of these incidents were Staphylococcus aureus infections. While 51.3 percent or 2602 cases of reported S. aureus bloodstream infections were found to be methicillin-sensitive and 37.9 percent or 1923 cases were recognized as MRSA. The data showed that around 545 incidents, or 10.7 percent, had not been reported as vulnerability tests. The risk of S.aureus bloodstream infections in bloodstreams was strongly linked to the type of patient’s vascular access. CVC type was found to be associated with six times more risk than fistula accessibility, and graft was associated with two times the risk of Staphylococcus aureus bloodstream infection. The study’s health experts found that the major factors associated with higher S. aureus infection frequencies were not being affiliated with a chain or hospital affiliation, location in an area that has a greater number of elderly people, and not having a properly-written antibiotic use strategy. Other variables that are associated with higher rates of infection include male sex and age 65+. CVC access was found to have the strongest correlation with all factors. However, the highest incidences of infections in Black patients were observed between the ages of 18 and 49 years. CVCs were found in around 65 percent of bloodstream infection cases across all age groups, races, and ethnicities. These researchers claimed that despite these findings they need to consider the possible link between race and ethnicity as well as the type of vascular access used. According to the most recent national data, the starting of hemodialysis with CVC does not differ by race, socioeconomic status, or ethnicity. Other reports, however, have identified links between Hispanic race, Black race, and insurance status. These also indicate a shorter duration of pre-ESKD treatments with lower initiation with fistula. The study was limited by the inability to examine SVI data below the county-level, and the fact that individual SES factors were not measured using the U.S. Census Bureau tract denominator data. According to the study’s authors, health officials need to improve the surveillance of bloodstream infection in hemodialysis to monitor the social aspects of health. This will allow for a better understanding of the risk to healthcare providers and help to address some of the limitations.
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