Rationale & Objective

Compared with conventional (rope-ladder cannulation [RLC]) methods, use of buttonhole cannulation (BHC) to access arteriovenous fistulas (AVFs) may be associated with increased risk for bloodstream infection and other vascular access–related infection. We used national surveillance data to evaluate the infection burden and risk among in-center hemodialysis patients with AVFs using BHC.

Study Design

Descriptive analysis of infections and related events and retrospective observational cohort study using National Healthcare Safety Network (NHSN) surveillance data.

Setting & Participants

US patients receiving hemodialysis treated in outpatient dialysis centers.

Predictors

AVF cannulation methods, dialysis facility characteristics, and infection control practices.

Outcomes

Access-related bloodstream infection; local access-site infection; intravenous (IV) antimicrobial start.

Analytic Approach

Description of frequency and rate of infections; adjusted relative risk (aRR) for infection with BHC versus RLC estimated using Poisson regression.

Results

During 2013 to 2014, there were 2,466 access-related bloodstream infections, 3,169 local access-site infections, and 13,726 IV antimicrobial starts among patients accessed using BHC. Staphylococcus aureus was the most common pathogen, present in half (52%) of the BHC access–related bloodstream infections. Hospitalization was frequent among BHC access–related bloodstream infections (37%). In 2014, 9% (n = 271,980) of all AVF patient-months reported to NHSN were associated with BHC. After adjusting for facility characteristics and practices, BHC was associated with significantly higher risk for access-related bloodstream infection (aRR, 2.6; 95% CI, 2.4-2.8) and local access-site infection (aRR, 1.5; 95% CI, 1.4-1.6) than RLC, but was not associated with increased risk for IV antimicrobial start.

Limitations

Data for facility practices were self-reported and not patient specific.

Conclusions

BHC was associated with higher risk for vascular access–related infection than RLC among in-center hemodialysis patients. Decisions regarding the use of BHC in dialysis centers should take into account the higher risk for infection. Studies are needed to evaluate infection control measures that may reduce infections related to BHC.

中文翻译：

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与瘘管扣眼插管相关的血管通路感染风险：来自国家医疗保健安全网络的数据。

基本原理和目标

与传统的（绳梯插管 [RLC]）方法相比，使用纽孔插管（BHC）进入动静脉瘘（AVF）可能会增加血流感染和其他血管通路相关感染的风险。我们使用国家监测数据来评估使用 BHC 进行 AVF 的中心血液透析患者的感染负担和风险。

学习规划

使用国家医疗保健安全网络 (NHSN) 监测数据对感染和相关事件进行描述性分析和回顾性观察性队列研究。

设置与参与者

在门诊透析中心接受血液透析的美国患者。

预测器

AVF 插管方法、透析设施特点和感染控制措施。

结果

通路相关的血流感染；本地访问站点感染；静脉内 (IV) 抗菌药物开始。

分析法

描述感染的频率和比率；使用泊松回归估计的 BHC 与 RLC 感染的调整相对风险 (aRR)。

结果

在 2013 年至 2014 年期间，使用 BHC 的患者中有 2,466 例与通路相关的血流感染、3,169 例局部通路部位感染和 13,726 例 IV 抗生素开始使用。金黄色葡萄球菌是最常见的病原体，存在于半数（52%）的 BHC 通路相关血流感染中。BHC 通路相关的血流感染中住院率较高（37%）。2014 年，向 NHSN 报告的所有 AVF 患者月中有 9%（n = 271,980）与 BHC 相关。在调整设施特征和实践后，BHC 与通路相关血流感染（aRR，2.6；95% CI，2.4-2.8）和局部通路部位感染（aRR，1.5；95% CI，1.4 -1.6) 比 RLC，但与 IV 抗菌药物开始的风险增加无关。

限制

设施实践的数据是自我报告的，而不是特定于患者的。

结论

在中心血液透析患者中​​，BHC 与血管通路相关感染的风险高于 RLC。关于在透析中心使用 BHC 的决定应考虑到较高的感染风险。需要研究来评估可能减少与 BHC 相关的感染的感染控制措施。