title: Factors associated with the receipt of antimicrobials among chronic hemodialysis patients.
abstract: Antimicrobial use is common among patients receiving chronic hemodialysis (CHD) and may represent an important antimicrobial stewardship opportunity. The objective of this study is to characterize CHD patients at increased risk of receiving antimicrobials, including not indicated antimicrobials.
  
  
  
  We conducted a prospective cohort study over a 12-month period among patients receiving CHD in 2 outpatient dialysis units. Each parenteral antimicrobial dose administered was characterized as indicated or not indicated based on national guidelines. Patient factors associated with receipt of antimicrobials and receipt of ≥1 inappropriate antimicrobial dose were analyzed.
  
  
  
  A total of 89 of 278 CHD patients (32%) received ≥1 antimicrobial doses and 52 (58%) received ≥1 inappropriately indicated dose. Patients with tunneled catheter access, a history of colonization or infection with a multidrug-resistant organism, and receiving CHD sessions during daytime shifts were more likely to receive antimicrobials (odds ratio [OR], 5.16; 95% confidence interval [CI], 2.72-9.80; OR, 5.43; 95% CI, 1.84-16.06; OR, 4.59; 95% CI, 1.20-17.52, respectively). Patients with tunneled catheter access, receiving CHD at dialysis unit B, and with a longer duration of CHD prior to enrollment were at higher risk of receiving an inappropriately indicated antimicrobial dose (incidence rate ratio, 2.23; 95% CI, 1.16-4.29; incidence rate ratio, 2.67; 95% CI, 1.34-5.35; incidence rate ratio, 1.11; 95% CI, 1.01-1.23, respectively).
  
  
  
  This study of all types of antimicrobials administered in 2 outpatient dialysis units identified several important factors to consider when developing antimicrobial stewardship programs in this health care setting.
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: gsnyder@bidmc.harvard.edu.
authors.forename: Graham M
authors.initials: GM
authors.lastname: Snyder
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kallen
authors.affiliation: St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: James A
authors.initials: JA
authors.lastname: Strom
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Tucker
authors.affiliation: Rhode Island Hospital, Brown University School of Medicine, Providence, RI.
authors.forename: Erika M C
authors.initials: EM
authors.lastname: D'Agata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents
keywords: Hemodialysis; antimicrobial stewardship; multidrug-resistant organism