Abstract
Background
25% of patients on hemodialysis receive therapy via a tunneled dialysis catheter (TDC). Bacteremia is one of the most feared complications with an all-cause mortality rate of 12–25%, Medicare spending costs amounting nearly $600 million annually and average hospital length of stay of 12 days per episode. The ClearGuard HD chlorhexidine impregnated catheter (ClearGuard cap) has recently shown potential to significantly reduce rates of bacteremia.
Methods
Retrospective review of 150 patients receiving hemodialysis at a single outpatient center in Brooklyn, NY from January 1, 2015 to January 31, 2019. As of February 1, 2019, the ClearGuard cap was implemented for all patients. Poisson regression was used to estimate crude event rate for both pre- and post-intervention periods, with 95% Wald-based confidence intervals (CI). Follow-up for pre-intervention cases terminated at the date the intervention was introduced. A likelihood ratio test of difference in incidence pre vs. post-intervention was conducted. A Kaplan–Meier (K-M) plot of time from the first dialysis since January 2015 to first infection was constructed (pre-intervention cases only). Subsequent subgroup analyses distinguished TDC vs. other patients. The log-rank test was used to test differences between subgroups; Bonferroni corrections to P-values were applied to address the multiple testing problem.
Results
Median total tracking period (including post-infection follow-up) was 1.75 years (range 0.02–4.26) for pre-intervention cases; 0.19 years (range 0.08–0.21) for post-intervention cases. Event rate was estimated as 9.7 events per 100 person-years (95% CI 6.7, 14.1) for pre-intervention cases; zero (95% CI 0.0, infinity) for post-intervention cases (P = 0.318 for pre- vs. post-comparison) with a clear limitation being lack of power given recent implementation date. We found a statistically significant risk for infection in patients with TDC (P < 0.001).
Conclusion
In an underserved, poorly health literate, largely foreign-born, socioeconomically challenged population such as ours, we not only established a significant risk of bacteremia with TDC’s but preliminary post-ClearGuard cap conception data currently being followed is promising for a significant reduction in catheter-related bacteremia.
Disclosures
All authors: No reported disclosures.
Session: 142. HAI, Device-Associated: Vascular Devices
Friday, October 4, 2019: 12:15 PM