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Changes in vascular accesses and in incidence rates of dialysis-related bloodstream infections in Québec, Canada, 2011–2017

  • Élise Fortin (a1) (a2), Manale Ouakki (a1), Claude Tremblay (a3), Jasmin Villeneuve (a1), Simon Desmeules (a3) (a4), Natasha Parisien (a1), Danielle Moisan (a5), Charles Frenette (a6) and for SPIN-BAC-HD (a1) (a2) (a3) (a4) (a5) (a6)...



Surveillance of dialysis-related bloodstream infections (DRBSIs) has been mandatory in Québec since April 2011. The aim of this study was to describe the epidemiology of DRBSIs in Québec.


Cohort study of prevalent patients undergoing chronic dialysis in the 36 facilities that participated without interruption in the provincial surveillance, between April 2011 and March 2017. Two indicators were analyzed: proportion of patient months dialyzed using a fistula (a patient month is a 28-day cycle during which an individual patient received dialysis) and incidence rate of DRBSI. Binomial and Poisson regression with generalized estimating equations were used to describe the evolution of indicators over time and to quantify the association between facilities’ proportion of fistulas and their incidence rate.


Globally, 42.6% of all patient months were dialyzed using a fistula, but there was a statistically significant decrease over time (46.2% in 2011–2012 to 39.3% in 2016–2017). Despite this decline in the use of fistulas, rates of DRBSIs have also decreased, going from 0.38 DRBSIs per 100 patient months in 2011–2012 to 0.23 DRBSIs per 100 patient months in 2016–2017. No association was found between facility use of fistulas and the rate of DRBSI. At the individual level, however, the DRBSI rate was 4.12 times higher for patients using a catheter.


In Québec, the rate of DRBSIs has decreased over a 6-year period despite an increasing proportion of patients dialyzed by catheter.


Corresponding author

Author for correspondence: Élise Fortin, Email:


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1. Brescia, MJ, Cimino, JE, Appel, K, Hurwich, BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966;275:10891092.
2. Frenette, C, Meunier, L, Moore, D, Tremblay, C. Rapport de surveillance des bactériémies nosocomiales—Novembre 2000 à mai 2001. Québec: Direction générale de la Santé Publique du MSSS; 2002. 37 p.
3. Fistula first catheter last. End stage renal disease national coordinating center website. Published in 2018. Accessed March 11, 2019.
4. Gupta, N, Cannon, M, Srinivasan, A, for the members of the Working Group of the Federal Steering Committee for the Prevention of Healthcare-Associated Infections in End-Stage Renal Disease Facilities. National agenda for prevention of healthcare-associated infections in dialysis centers. Semin Dial 2013;26:376383.
5. Comité des infections nosocomiales du Québec. La prévention des bactériémies associées aux accès vasculaires en hémodialyse. Québec: Institut national de santé publique du Québec; 2014, 17 p.
6. Woo, K, Lok, CE. New insights into dialysis vascular access: what is the optimal vascular access type and timing of access creation in CKD and dialysis patients? Clin J Am Soc Nephrol 2016;11:14871494.
7. Xi, W, Harwood, L, Diamant, MJ, et al. Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making. Nephrol Dial Transpl 2011;26:33023308.
8. Comités de surveillance SPIN-BACTOT, SPIN-BACC et SPIN-HD. Surveillance provinciale des bactériémies nosocomiales au Québec - Protocole. Québec: Institut national de santé publique du Québec. Published 2019. Accessed March 11, 2019.
9. Department of Health. Healthcare infection surveillance Western Australia - annual report 2015-16. Western Australia: Department of Health; 2016, 56 p.
10. Réseau DIALIN. Surveillance des infections des voies d’abord vasculaires en hémodialyse - Résultats annuels 2016. Saint-Genis-Laval: CPias Auvergne-Rhône-Alpes; 2017, 101 p.
11. Nguyen, DB, Shugart, A, Lines, C, et al. National Healthcare Safety Network (NHSN) dialysis event surveillance report for 2014. Clin J Am Soc Nephrol 2017;12:11391146.
12. AQESSS, INSPQ. La prévention des bactériémies associées aux cathéters vasculaires centraux. Québec: Institut national de santé publique du Québec; 2014, 29 p.
13. Comité de surveillance provinciale des infections nosocomiales. Bactériémies associées aux accès vasculaires en hémodialyse—résultats de surveillance 2016–2017. Institut national de santé publique website. Published 2018. Accessed July 31, 2018.
14. Comité de surveillance provinciale des infections nosocomiales. Surveillance provinciale des infections nosocomiales: faits saillants, discussions et orientations 2016–2017. Institut national de santé publique website. Published 2018. Accessed March 11, 2019.
15. Trépanier, P, Quach, C, Gonzales, M, et al. Survey of infection control practices in hemodialysis units: preventing vascular access–associated bloodstream infections. Infect Control Hosp Epidemiol 2014;35:833838.
16. Ethier, J, Mendelssohn, DC, Elder, SJ, et al. Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transpl 2008;23:32193226.
17. Mendelssohn, DC, Ethier, J, Elder, SJ, Saran, R, Port, FK, Pisoni, RL. Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Nephrol Dial Transplant 2006;21:721728.
18. Lata, C, Girard, L, Parkins, M, James, MT. Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review. Can J Kidney Health Dis 2016;3:115.
19. Morgenstern, H. Ecologic studies. In: Modern Epidemiology – Second Edition. Philadelphia, PA: Lippincott-Raven; 1998: 469471.
20. Population du Québec, 1971–2017. Institut de la statistique du Québec website. Published 2017. Accessed March 11, 2019.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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