Can intravenous antimicrobial start data reported to the National Healthcare Safety Network determine appropriateness of antibiotic use in hemodialysis patients?

• Authors: Priti Patel, Emory University; Shannon Novosad, Emory University; Ibironke Apata, Emory University
• Journal Title: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
• Volume: Volume 43, Number 5
• Publisher: CAMBRIDGE UNIV PRESS | 2021-02-09, Pages 674-675
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1017/ice.2021.55
• Subjects: Health Sciences, Health Care Management
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Infectious Diseases

Abstract

To the Editor—In their article, “Inappropriate intravenous antimicrobial starts: An antimicrobial stewardship metric for hemodialysis facilities,” Hahn et al1 describe their application of data reported to CDC’s National Healthcare Safety Network (NHSN) to determine appropriateness of IV antibiotic use in outpatient hemodialysis centers. NHSN’s Dialysis Event (DE) surveillance system was designed to track bloodstream infections (BSIs) and other vascular access infections in hemodialysis outpatients through monitoring of events such as positive blood cultures. The authors examined outpatient IV antimicrobial start (IVAS) events reported to NHSN and considered any IVAS without documentation of coreported positive blood culture, collection of blood sample for culture, or local access site infection to be inappropriate, even when symptoms such as fever, chills, rigors, or drop in blood pressure were present. We applaud these investigators for drawing necessary attention to the issue of antibiotic use in dialysis patients, which is an important area of study with limited data, and for exploring the use of data to inform improvement in practice. However, we have concerns about their approach to the categorization of antibiotic use without incorporation of relevant clinical information or validation of NHSN data for this purpose, and the potential for unintended consequences among patients at high risk for infections and sepsis.