Bloodstream Infections in the Context of Hemodialysis Care: Experience in a Wide Mexican Renal Health Network

Background: Infections are the 2nd cause of morbidity and mortality among hemodyalisis (HD) patients with chronic kidney disease (CKD). Preventing blood stream infections (BSIs) is challenging due to several factors. In our cohort, about 60% of patients use catheters, which is below the national average. Here we detail the experience and trends in BSI rates at our centers from 2019 to 2023, considering the interventions implemented. Methods: Data on BSI rates and isolated microorganisms were extracted from our electronic records. Catheter-days BSI rates were calculated. Through a chronological timeline, we described the interventions implemented in accordance with our protocols. Results: By the end of 2023, around 2,300 individuals were receiving HD at our centers. The annual infection rates from 2019 to 2023 were 0.73, 0.81, 1.24, 0.42, and 0.50, respectively. COVID-19 lockdown in Mexico started on Apr 2020. By 2021, we started taking care of over 1,000 individuals from a new HD clinic, lacking established BSI prevention protocols, which led to a spike in BSI rates. We implemented these measures: Formed small teams within large centers (over 500 patients) to better assess BSI risk (Int 1). Developed an emergency alert and used gentamycin preventive locks when an outbreak was detected (Int 2). The strategies resulted in a 66% reduction in BSIs, sustained during follow-up. The most frequently isolated gram-positive cocci (GPC) and gram-negative rods (GNR) were S. aureus and Enterobacter sp., respectively. We did not observe increased antibiotic resistance with the use of gentamycin locks. Conclusion: The enhancement of surveillance for individuals at higher risk of BSIs through the establishment of specialized teams within large HD centers, and the use of gentamicin preventive locks has proven effective in reducing BSI rates. Funding: Clinical Revenue Support