Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities: A Report From the American Society of Nephrology and Centers for Disease Control and Prevention Antibiotic Stewardship White Paper Writing Group

• Authors: Ibironke Apata, Emory University; Sarah Kabbani, Centers for Disease Control and Prevention; Alicia M. Neu, Johns Hopkins School of Medicine; Tamara M. Kear, Villanova University; Erika M. C. D'Agata, Brown University; David J. Levenson, Partners in Nephrology and Endocrinology; Alan S. Kliger, Yale University; Lauri A. Hicks, Centers for Disease Control and Prevention; Priti Patel, Emory University
• Journal Title: AMERICAN JOURNAL OF KIDNEY DISEASES
• Volume: Volume 77, Number 5
• Publisher: W B SAUNDERS CO-ELSEVIER INC | 2021-04-21, Pages 757-768
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1053/j.ajkd.2020.08.011
• Subjects: Health Sciences, Health Care Management; Health Sciences, Immunology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Urology & Nephrology; STAPHYLOCOCCUS-AUREUS INFECTIONS; CLINICAL-PRACTICE GUIDELINES; EVENT SURVEILLANCE REPORT; SAFETY NETWORK NHSN; ANTIMICROBIAL USE; BEHAVIORAL INTERVENTIONS; DIALYSIS PATIENTS; RISK-FACTORS; CARE; EPIDEMIOLOGY

Abstract

Antibiotic use is necessary in the outpatient hemodialysis setting because patients receiving hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. The American Society of Nephrology and the US Centers for Disease Control and Prevention created the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients receiving maintenance hemodialysis. Based on existing evidence and the unique patient and clinical setting characteristics, the following strategies for improving antibiotic use are reviewed: expanding infection and sepsis prevention activities, standardizing blood culture collection processes, treating methicillin-susceptible Staphylococcus aureus infections with β-lactams, optimizing communication between nurses and prescribing providers, and improving data sharing across transitions of care. Collaboration among the Centers for Disease Control and Prevention; American Society of Nephrology; other professional societies such as infectious diseases, hospital medicine, and vascular surgery societies; and dialysis provider organizations can improve antibiotic use and the quality of care for patients receiving maintenance hemodialysis.