title: Vascular access-related bloodstream infections in First Nations, community and teaching Canadian dialysis units, and other centre-level predictors.
abstract: OBJECTIVE
  Vascular access-related bloodstream infection (BSI) is frequent among patients undergoing hemodialysis increasing their morbidity and mortality, but its occurrence across various dialysis centre types is not known. The aims of this study were to describe the incidence rates and assess the variability in BSI risk between dialysis centre types and other centre-level variables.
  
  
  METHODS
  We conducted a retrospective cohort study of 621 patients initiating hemodialysis in 7 Canadian dialysis centres. Cox regression models, where access type was continuously updated, were used to identify predictors of BSI occurrence.
  
  
  RESULTS
  During follow-up of the cohort (median age 68.1 years, 41.7% female, and 76.7% initiating with a central venous catheter, CVC), 73 patients had a BSI (rate: 0.21/1000 person-days). The BSI risk was not different in First Nation units (adjusted relative risk: 0.47, 95% confidence interval: 0.06-3.72) and teaching hospitals (1.33, 0.70-2.54) compared to community hospitals. No other centre-related variables were associated with the risk of BSI.
  
  
  CONCLUSIONS
  We did not find differences in the BSI risk among dialysis unit types, or any other centre-related variables. The rates of BSI in our population were lower than those observed in other settings, but the high proportion of patients using CVCs is concerning.
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. jean-philippe.lafrance@mail.mcgill.ca
authors: Jean-Philippe
authors: JP
authors: Lafrance
authors: Sameena
authors: S
authors: Iqbal
authors: Jacques
authors: J
authors: Lelorier
authors: Kaberi
authors: K
authors: Dasgupta
authors: Judith
authors: J
authors: Ritchie
authors: Linda
authors: L
authors: Ward
authors: Samuel
authors: S
authors: Benaroya
authors: Paul
authors: P
authors: Barré
authors: Marcelo
authors: M
authors: Cantarovich
authors: Marc
authors: M
authors: Ghannoum
authors: Normand
authors: N
authors: Proulx
authors: Murray
authors: M
authors: Vasilevsky
authors: Elham
authors: E
authors: Rahme
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D003151:Community Health Centers / Q000706:statistics & numerical data*; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D005112:Extracorporeal Circulation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors