Last data update: Dec 09, 2024. (Total: 48320 publications since 2009)
Records 1-12 (of 12 Records) |
Query Trace: Apata I[original query] |
---|
Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis
Bardossy AC , Korhonen L , Schatzman S , Gable P , Herzig C , Brown NE , Beshearse E , Varela K , Sabour S , Lyons AK , Overton R , Hudson M , Hernandez-Romieu AC , Alvarez J , Roman K , Weng M , Soda E , Patel PR , Grate C , Dalrymple LS , Wingard RL , Thornburg NJ , Halpin ASL , Folster JM , Tobin-D'Angelo M , Lea J , Apata I , McDonald LC , Brown AC , Kutty PK , Novosad S . Kidney360 12/28/2021 2 (12) 1917-1927 BACKGROUND: Patients with ESKD on maintenance dialysis receive dialysis in common spaces with other patients and have a higher risk of severe SARS-CoV-2 infections. They may have persistently or intermittently positive SARS-CoV-2 RT-PCR tests after infection. We describe the clinical course of SARS-CoV-2 infection and the serologic response in a convenience sample of patients with ESKD to understand the duration of infectivity. METHODS: From August to November 2020, we enrolled patients on maintenance dialysis with SARS-CoV-2 infections from outpatient dialysis facilities in Atlanta, Georgia. We followed participants for approximately 42 days. We assessed COVID-19 symptoms and collected specimens. Oropharyngeal (OP), anterior nasal (AN), and saliva (SA) specimens were tested for the presence of SARS-CoV-2 RNA, using RT-PCR, and sent for viral culture. Serology, including neutralizing antibodies, was measured in blood specimens. RESULTS: Fifteen participants, with a median age of 58 (range, 37‒77) years, were enrolled. Median duration of RT-PCR positivity from diagnosis was 18 days (interquartile range [IQR], 8‒24 days). Ten participants had at least one, for a total of 41, positive RT-PCR specimens ≥10 days after symptoms onset. Of these 41 specimens, 21 underwent viral culture; one (5%) was positive 14 days after symptom onset. Thirteen participants developed SARS-CoV-2-specific antibodies, 11 of which included neutralizing antibodies. RT-PCRs remained positive after seroconversion in eight participants and after detection of neutralizing antibodies in four participants; however, all of these samples were culture negative. CONCLUSIONS: Patients with ESKD on maintenance dialysis remained persistently and intermittently SARS-CoV-2-RT-PCR positive. However, of the 15 participants, only one had infectious virus, on day 14 after symptom onset. Most participants mounted an antibody response, including neutralizing antibodies. Participants continued having RT-PCR-positive results in the presence of SARS-CoV-2-specific antibodies, but without replication-competent virus detected. |
Intravenous antimicrobial starts among hemodialysis patients in the National Healthcare Safety Network Dialysis Component, 2016-2020
Wilson WW , Gouin KA , Fike L , Apata IW , Bell JM , Edwards JR , Novosad S , Kabbani S . Kidney360 2023 4 (7) 971-975 NHSN total IV antimicrobial start rates for patients on hemodialysis decreased from 2016-2020, | but rates unsupported by NHSN surveillance documentation did not. | 80% of reporting hemodialysis facilities had ≥1 unsupported IV antimicrobial start and the | fraction of facilities with unsupported starts increased yearly. | Accurate reporting and timely review of antimicrobial data is critical to understanding | prescribing trends and practices in hemodialysis facilities. |
Vital Signs: Health disparities in hemodialysis-associated staphylococcus aureus bloodstream infections - United States, 2017-2020
Rha B , See I , Dunham L , Kutty PK , Moccia L , Apata IW , Ahern J , Jung S , Li R , Nadle J , Petit S , Ray SM , Harrison LH , Bernu C , Lynfield R , Dumyati G , Tracy M , Schaffner W , Ham DC , Magill SS , O'Leary EN , Bell J , Srinivasan A , McDonald LC , Edwards JR , Novosad S . MMWR Morb Mortal Wkly Rep 2023 72 (6) 153-159 INTRODUCTION: Racial and ethnic minorities are disproportionately affected by end-stage kidney disease (ESKD). ESKD patients on dialysis are at increased risk for Staphylococcus aureus bloodstream infections, but racial, ethnic, and socioeconomic disparities associated with this outcome are not well described. METHODS: Surveillance data from the 2020 National Healthcare Safety Network (NHSN) and the 2017-2020 Emerging Infections Program (EIP) were used to describe bloodstream infections among patients on hemodialysis (hemodialysis patients) and were linked to population-based data sources (CDC/Agency for Toxic Substances and Disease Registry [ATSDR] Social Vulnerability Index [SVI], United States Renal Data System [USRDS], and U.S. Census Bureau) to examine associations with race, ethnicity, and social determinants of health. RESULTS: In 2020, 4,840 dialysis facilities reported 14,822 bloodstream infections to NHSN; 34.2% were attributable to S. aureus. Among seven EIP sites, the S. aureus bloodstream infection rate during 2017-2020 was 100 times higher among hemodialysis patients (4,248 of 100,000 person-years) than among adults not on hemodialysis (42 of 100,000 person-years). Unadjusted S. aureus bloodstream infection rates were highest among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) hemodialysis patients. Vascular access via central venous catheter was strongly associated with S. aureus bloodstream infections (NHSN: adjusted rate ratio [aRR] = 6.2; 95% CI = 5.7-6.7 versus fistula; EIP: aRR = 4.3; 95% CI = 3.9-4.8 versus fistula or graft). Adjusting for EIP site of residence, sex, and vascular access type, S. aureus bloodstream infection risk in EIP was highest in Hispanic patients (aRR = 1.4; 95% CI = 1.2-1.7 versus non-Hispanic White [White] patients), and patients aged 18-49 years (aRR = 1.7; 95% CI = 1.5-1.9 versus patients aged ≥65 years). Areas with higher poverty levels, crowding, and lower education levels accounted for disproportionately higher proportions of hemodialysis-associated S. aureus bloodstream infections. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Disparities exist in hemodialysis-associated S. aureus infections. Health care providers and public health professionals should prioritize prevention and optimized treatment of ESKD, identify and address barriers to lower-risk vascular access placement, and implement established best practices to prevent bloodstream infections. |
SARS-CoV-2 Infections among Vaccinated Patients on Maintenance Dialysis, January 1-August 31, 2021, United States.
Bardossy AC , Angeles J , Booth S , Fike L , Wadley A , Rha B , Lacson E Jr , Manley HJ , Johnson D , Apata IW , Novosad S . Kidney360 2022 3 (11) 1934-1938 Dialysis facilities voluntarily reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in vaccinated dialysis patients detected between January 1, 2021, and August 31, 2021, to the Centers for Disease Control and Prevention.Among 4087 patients reported, most were symptomatic, a third required hospitalization, and 9% died within 30 days of diagnosis.Monitoring SARS-CoV-2 infections and outcomes among vaccinated people on dialysis provides valuable insight into this population. |
Absence of SARS-CoV-2 infections among patients with end-stage renal disease following facility-wide testing in four outpatient hemodialysis facilities.
Wilson WW , Bardossy AC , Gable P , Herzig C , Beshearse E , Gualandi N , Sabour S , Brown N , Brown AC , Kutty P , Tobin-D'Angelo M , Lea JP , Apata IW , Novosad S , Hudson M , Hernandez-Romieu AC , Tobolowsky F , Lyons A , Gilbert S , Soda E , Biedron C , Korhonen L . Am J Infect Control 2021 49 (10) 1318-1321 Facility-wide testing performed at four outpatient hemodialysis facilities in the absence of an outbreak or escalating community incidence did not identify new SARS-CoV-2 infections and illustrated key logistical considerations essential to successful implementation of SARS-CoV-2 screening. Facilities could consider prioritizing facility-wide SARS-CoV-2 testing during suspicion of an outbreak in the facility or escalating community spread without robust infection control strategies in place. Being prepared to address operational considerations will enhance implementation of facility-wide testing in the outpatient dialysis setting. |
Suggestions for the prevention of Clostridioides difficile spread within outpatient hemodialysis facilities
D'Agata EMC , Apata IW , Booth S , Boyce JM , Deaver K , Gualandi N , Neu A , Nguyen D , Novosad S , Palevsky PM , Rodgers D . Kidney Int 2021 99 (5) 1045-1053 Clostridioides difficile infections (CDI) cause substantial morbidity and mortality. Patients on maintenance hemodialysis (MHD) are 2-2.5 times more likely to develop CDI with mortality rates 2-fold higher than the general population. Hospitalizations due to CDI among the MHD population are high and the frequency of antibiotic exposures and hospitalizations may contribute to CDI risk. In this report, a panel of experts in clinical nephrology, infectious diseases, and infection prevention provide guidance, based on expert opinion and published literature, aimed at preventing the spread of CDI in outpatient hemodialysis facilities. |
Can intravenous antimicrobial start data reported to the National Healthcare Safety Network determine appropriateness of antibiotic use in hemodialysis patients
Patel PR , Novosad SA , Apata IW . Infect Control Hosp Epidemiol 2021 43 (5) 1-6 In their article, “Inappropriate intravenous antimicrobial starts: An antimicrobial stewardship metric for hemodialysis facilities,” Hahn et al Reference Hahn, Figgatt, Peritz and Coffin1 describe their application of data reported to CDC’s National Healthcare Safety Network (NHSN) to determine appropriateness of IV antibiotic use in outpatient hemodialysis centers. NHSN’s Dialysis Event (DE) surveillance system was designed to track bloodstream infections (BSIs) and other vascular access infections in hemodialysis outpatients through monitoring of events such as positive blood cultures. The authors examined outpatient IV antimicrobial start (IVAS) events reported to NHSN and considered any IVAS without documentation of coreported positive blood culture, collection of blood sample for culture, or local access site infection to be inappropriate, even when symptoms such as fever, chills, rigors, or drop in blood pressure were present. We applaud these investigators for drawing necessary attention to the issue of antibiotic use in dialysis patients, which is an important area of study with limited data, and for exploring the use of data to inform improvement in practice. However, we have concerns about their approach to the categorization of antibiotic use without incorporation of relevant clinical information or validation of NHSN data for this purpose, and the potential for unintended consequences among patients at high risk for infections and sepsis. |
Opportunities to improve antibiotic prescribing in outpatient hemodialysis facilities
Apata IW , Kabbani S , Neu AM , Kear TM , D'Agata EMC , Levenson DJ , Kliger AS , Hicks LA , Patel PR . Am J Kidney Dis 2020 77 (5) 757-768 Antibiotic use is necessary in the outpatient hemodialysis setting, as patients on hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. The American Society of Nephrology (ASN) and the Centers for Disease Control and Prevention (CDC) created the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients on maintenance hemodialysis. Based on existing evidence and the unique patient and clinical setting characteristics, the following strategies for improving antibiotic use are reviewed: expanding infection and sepsis prevention activities, standardizing blood culture collection processes, treating methicillin-susceptible Staphylococcus aureus infections with β-lactams, optimizing communication between nurses and prescribing providers, and improving data sharing across transitions of care. Collaboration between CDC, ASN, other professional societies such as infectious diseases, hospital medicine and vascular surgery societies, and dialysis provider organizations can improve antibiotic use and the quality of care for patients on maintenance hemodialysis. |
Vascular access and risk of bloodstream infection among older incident hemodialysis patients
Kazakova SV , Baggs J , Apata IW , Yi SH , Jernigan JA , Nguyen D , Patel PR . Kidney Med 2020 2 (3) 276-285 Rationale & Objective: Most new patients with end-stage renal disease (ESRD) initiate hemodialysis (HD) with a central venous catheter (CVC) and later transition to a permanent vascular access with lower infection risk. The benefit of early fistula use in preventing severe infections is incompletely understood. We examined patients’ first access and subsequent transitions between accesses during the first year of HD to estimate the risk for bloodstream infection (BSI) associated with incident and time-dependent use of HD access. Study Design: A retrospective cohort study using enhanced 5% Medicare claims data. Setting & Participants: New patients with ESRD initiating HD between January 1, 2011, and December 31, 2012, and having complete pre-ESRD Medicare fee-for-service coverage for 2 years. Exposure: The incident and prevalent use of CVC, graft, or fistula as determined from monthly reports to the Centers for Medicare & Medicaid Services by HD providers. Outcome: Incident hospitalization with a primary/secondary diagnosis of BSI (International Classification of Diseases, Ninth Revision, Clinical Modification code 038.xx or 790.7). Analytical Approach: Extended survival analysis accounting for patient confounders. Results: Of 2,352 study participants, 1,870 (79.5%), 77 (3.3%), and 405 (17.2%) initiated HD with a CVC, graft, and fistula, respectively. During the first year, the incident BSI hospitalization rates per 1,000 person-days were 1.3, 0.8, and 0.3 (P<0.001) in patients initiating with a CVC, graft, and fistula, respectively. After adjusting for confounders, incident fistula use was associated with 61% lower risk for BSI (HR, 0.39; 95% CI, 0.28-0.54; P<0.001) compared with incident CVC or graft use. The prevalent fistula or graft use was associated with lower risk for BSI compared with prevalent CVC use (HRs of 0.30 [95% CI, 0.22-0.42] and 0.47 [95% CI, 0.31-0.73], respectively). Limitations: Restricted to an elderly population; potential residual confounding. Conclusions: Incident fistula use was associated with lowest rates of BSI, but the majority of beneficiaries with pre-ESRD insurance initiated HD with a CVC. Strategies are needed to improve pre-ESRD fistula placement. |
Hepatitis B virus mutant infections in hemodialysis patients: A case series
Apata IW , Nguyen DB , Khudyakov Y , Mixson-Hayden T , Rosenberg J , Zahn M , Greenko J , Clement E , Portney AE , Kulkarni PA , Comer M , Adams E , Kamili S , Patel PR , Moorman AC . Kidney Med 2019 1 (6) 347-353 Rationale & Objective: Hepatitis B virus (HBV) transmission in hemodialysis units has become a rare event since implementation of hemodialysis-specific infection control guidelines: performing hemodialysis for hepatitis B surface antigen (HBsAg)-positive patients in an HBV isolation room, vaccinating HBV-susceptible (HBV surface antibody and HBsAg negative) patients, and monthly HBsAg testing in HBV-susceptible patients. Mutations in HBsAg can result in false-negative HBsAg results, leading to failure to identify HBsAg seroconversion from negative to positive. We describe 4 unique cases of HBsAg seroconversion caused by mutant HBV infection or reactivation in hemodialysis patients. Study Design: Following identification of a possible HBsAg seroconversion and mutant HBV infection, public health investigations were launched to conduct further HBV testing of case patients and potentially exposed patients. A case patient was defined as a hemodialysis patient with suspected mutant HBV infection because of false-negative HBsAg testing results. Confirmed case patients had HBV DNA sequences demonstrating S-gene mutations. Setting & Participants: Case patients and patients potentially exposed to the case patient in the respective hemodialysis units in multiple US states. Results: 4 cases of mutant HBV infection in hemodialysis patients were identified; 3 cases were confirmed using molecular sequencing. Failure of some HBsAg testing platforms to detect HBV mutations led to delays in applying HBV isolation procedures. Testing of potentially exposed patients did not identify secondary transmissions. Limitations: Lack of access to information on past HBsAg testing platforms and results led to challenges in ascertaining when HBsAg seroconversion occurred and identifying and testing all potentially exposed patients. Conclusions: Mutant HBV infections should be suspected in patients who test HBsAg negative and concurrently test positive for HBV DNA at high levels. Dialysis providers should consider using HBsAg assays that can also detect mutant HBV strains for routine HBV testing. |
Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania
Apata IW , Drammeh B , De AK , Bjork A , Pathak S , Lyimo M , Juma A , Kutaga R , Mahmoud M , Nkya E , Kuehnert M , Marfin A . Transfusion 2018 58 (2) 379-389 BACKGROUND: Resource-limited countries in Africa experience blood shortages. Understanding clinical drivers of blood demand can inform strategies to increase blood availability. STUDY DESIGN AND METHODS: From a national representative sample of 42 hospitals in Tanzania, patient records and requests for whole blood (WB) and red blood cells (RBCs) to treat anemia were analyzed using data collected prospectively from June through September 2013. Abstracted data included cause of anemia, number of requested units, clinical signs, and pretransfusion hemoglobin (Hb) levels. Weighted projections of nationwide drivers of blood demand for the year, 2013, were calculated. Mean posttransfusion Hb levels were estimated, and blood requests were assessed for clinical appropriateness. RESULTS: Malaria was the leading driver of blood demand for anemia among children, accounting for 67% (55,949 units; standard deviation [SD], 1911 units) of projected units requested for children in 2013. Maternal hemorrhage was the leading driver of blood demand for anemia among adults, accounting for 21% (31,321 units; SD, 963 units) of projected units requested. Seventeen percent (26,133 units; SD, 1013 units) of projected requested units were deemed inappropriate. Adults with severe anemia had a mean Hb level of 3.7 g/dL and a mean of 1.6 WB or RBC units per request, resulting in an estimated mean posttransfusion Hb level of 5.3 g/dL. CONCLUSIONS: Strategies to prevent and treat underlying causes of anemia and decrease inappropriate blood requests will likely increase blood availability. Restrictive blood ordering practices seen in adults with severe anemia suggests undertreatment of anemia and may result in an underestimation of the national blood demand. |
Progress toward prevention of transfusion-transmitted hepatitis B and hepatitis C infection - sub-Saharan Africa, 2000-2011
Apata IW , Averhoff F , Pitman J , Bjork A , Yu J , Amin NA , Dhingra N , Kolwaite A , Marfin A . MMWR Morb Mortal Wkly Rep 2014 63 (29) 613-9 Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of morbidity and mortality globally, primarily because of sequelae of chronic liver disease including cirrhosis and hepatocellular carcinoma. The risks for HBV and HCV transmission via blood transfusions have been described previously and are believed to be higher in countries in sub-Saharan Africa. Reducing the risk for transfusion-transmitted human immunodeficiency virus (HIV), HBV, and HCV infection is a priority for international aid organizations, such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Combat HIV/AIDS, Malaria, and Tuberculosis, and the World Health Organization (WHO). Over the last decade, PEPFAR and the Global Fund have supported blood safety programs in many sub-Saharan African countries with heavy burdens of HIV and acquired immunodeficiency syndrome (AIDS), hepatitis, malaria, and maternal mortality. This report summarizes HBV- and HCV-related surveillance data reported by the blood transfusion services of WHO member states to WHO's Global Database on Blood Safety (GDBS) (4). It also evaluates the performance of blood safety programs in screening for HBV and HCV in 38 sub-Saharan Africa countries.* Selected GDBS indicators were compared for the years 2000 and 2004 (referred to as the 2000/2004 period) and 2010 and 2011 (referred to as the 2010/2011 period). From 2000/2004 to 2010/2011, the median of the annual number of units donated per country increased, the number of countries screening at least 95% of blood donations for HBV and HCV increased, and the median of the national prevalence of HBV and HCV marker-reactive blood donations decreased. These findings suggest that during the past decade, more blood has been donated and screened for HBV and HCV, resulting in a safer blood supply. Investments in blood safety should be continued to further increase the availability and safety of blood products in sub-Saharan Africa. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Dec 09, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure