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

Published online by Cambridge University Press:  08 April 2019

Élise Fortin*
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Québec, Canada
Manale Ouakki
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
Claude Tremblay
Affiliation:
Centre hospitalier universitaire (CHU) de Québec, Québec, Canada
Jasmin Villeneuve
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
Simon Desmeules
Affiliation:
Centre hospitalier universitaire (CHU) de Québec, Québec, Canada Department of Medicine, Université Laval, Québec, Canada
Natasha Parisien
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
Danielle Moisan
Affiliation:
Centre intégré de santé et de services sociaux (CISSS) du Bas-Saint-Laurent, Québec, Canada
Charles Frenette
Affiliation:
Department of Medical Microbiology, McGill University Health Centre, Québec, Canada
for SPIN-BAC-HD
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Québec, Canada Centre hospitalier universitaire (CHU) de Québec, Québec, Canada Department of Medicine, Université Laval, Québec, Canada Centre intégré de santé et de services sociaux (CISSS) du Bas-Saint-Laurent, Québec, Canada Department of Medical Microbiology, McGill University Health Centre, Québec, Canada
*
Author for correspondence: Élise Fortin, Email: elise.fortin@inspq.qc.ca

Abstract

Objective:

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.

Methods:

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.

Results:

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.

Conclusions:

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

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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