Vascular Access–Related Bloodstream Infections in Hemodialysis Patients in Québec
Surveillance results: 2014-2015

From April 1st, 2014, to March 31st, 2015, 45 hemodialysis units took part in the surveillance of vascular access–related bloodstream infections (VARBSIs) in hemodialysis (HD) patients, for a combined total of 55,640 patient-periods (Table 1). Participating units reported 156 VARBSIs in 142 patients. The proportion of patient-periods involving a fistula accounted for 43.4%. The VARBSI incidence rate was 0.09 cases per 100 patient-periods for patients with an arteriovenous (AV) fistula, 0.20 for patients with a synthetic fistula (graft), 0.37 for patients with a permanent catheter and 6.73 for patients with a temporary catheter. In 2014–2015, incidence rates per type of vascular access were stable compared to 2010–2014, except for patients with a permanent catheter, which has significantly decreased (p < 0.01). Since 2013-2014, four HD units joined the program and one HD unit stopped participating. Data was extracted on May 20, 2015.

Updated : March 17, 2016

Table 1 – Participation of Hemodialysis Units in the Surveillance of VARBSIs in Hemodialysis Patients, Québec, 2010–2011 to 2014–2015

 

2010-2011

2011-2012

2012-2013

2013-2014

2014-2015

Units (N)

29

40

42

42

45

Patients monitored (average number per period)

3,311

3,855

3,977

3,984

4,280

Patient-periods* (N)

43,040

50,115

51,697

51,791

55,640

Patient-months (N)

40,276

47,041

48,340

48,469

52,001

Dialysis sessions (N)

517,835

604,817

621,516

623,172

668,590

Catheter-days (N)

655,588

750,919

798,816

824,834

883,423

VARBSIs (cat. 1a, 1b and 1c, N)

190

214

218

152

156

VARBSIs with AV fistulas or grafts (N)

29

38

46

25

24

VARBSIs with permanent or temporary catheters (N)

161

176

172

127

132

Infected patients (N)

182

206

210

150

142

The 2014-2015 VARBSI incidence rate was 0.28 cases per 100 patient-periods. The incidence rate was 0.09 for patients with an AV fistula, 0.20 for patients with a graft, 0.37 for patients with a permanent catheter and 6.73 for patients with a temporary catheter (Figure 1). In patients with AV fistulas, the VARBSI incidence rate was higher when the buttonhole technique was used (0.20 per 100 patient-periods versus 0.05, p < 0.01). Incidence rates were not statistically different between patients with an AV fistula with buttonhole and those with a graft, nor they were such difference between patients with a graft and those with a permanent catheter; however, the incidence rate for patients with an AV fistula with buttonhole was lower than the incidence rate for those with a permanent catheter (p < 0.03).

Therefore, compared to AV fistulas without buttonhole, the incidence rate with a temporary catheter was 123.6 [54.1 ; 282.3] times greater, with a permanent catheter 6.9 [3.5 ; 13.5] times greater, with a graft 3.6 [1.2 ; 10.8] times greater and with an AV fistula with a buttonhole, the incidence rate was 3.6 [1.5 ; 9.0] times greater (all p values < 0.05). The incidence rate with a temporary catheter was 18.0 [10.5 ; 30.8] times higher than with a permanent catheter (p < 0.05).

Figure 1 – VARBSI Incidence Rate by Type of Vascular Access, Québec, 2014–2015 (Incidence Rate per 100 Patient-periods [95% CI])

Figure 1 – VARBSI Incidence Rate by Type of Vascular Access, Québec, 2014–2015 (Incidence Rate per 100 Patient-periods [95% CI])

95% CI: 95% confidence interval.

Permanent catheters were the most commonly used type of vascular access, followed by AV fistulas without the use of the buttonhole technique (Figure 2).

Figure 2 – Breakdown of Patient-periods by Type of Vascular Access, Québec, 2014–2015 (%)

Figure 2 – Breakdown of Patient-periods by Type of Vascular Access, Québec, 2014–2015 (%)

In 2014–2015, incidence rates per type of vascular access were stable compared to 2010–2014, except for patients with a permanent catheter, which has significantly decreased (p < 0.01) (Table 2 and Figures 3 and 4).

Figure 3 – VARBSI Incidence Rates by Type of Vascular Access, Québec, 2010–2014 and 2014–2015 (Incidence Rate per 100 Patient-periods [95% CI])

Figure 3 – VARBSI Incidence Rates by Type of Vascular Access, Québec, 2010–2014 and 2014–2015 (Incidence Rate per 100 Patient-periods [95% CI])

Table 2 – VARBSI Incidence Rates by Type of Vascular Access, Québec, 2010–2014 and 2014–2015 (Incidence Rate per 100 Patient-periods and per 1,000 Vascular-Access Days [95% CI]

Type of Vascular Access

Incidence Rate/100 Patient-periods
[95% CI]

Incidence Rate/1,000 Vascular-Access Days
[95% CI]

2010-2014

2014-2015

2010-2014

2014-2015

AV fistula or graft

0.16 [0.13 ; 0.18]

0.10 [0.06 ; 0.14]

---

---

  AV fistula

0.15 [0.13 ; 0.18]

0.09 [0.05 ; 0.13]

---

---

    With buttonhole*

0.28 [0.16 ; 0.42]

0.20 [0.09 ; 0.34]

---

---

    Without buttonhole*

0.02 [0.00 ; 0.05]

0.05 [0.02 ; 0.10]

---

---

  Graft

0.19 [0.11 ; 0.29]

0.16 [0.04 ; 0.35]

---

---

Permanent or temporary catheter

0.59 [0.55 ; 0.64]

0.42 [0.35 ; 0.49]

0.21 [0.19 ; 0.23]

0.15 [0.12 ; 0.18]

Permanent catheter

0.53 [0.49 ; 0.57]

0.37 [0.31 ; 0.44]

0.19 [0.17 ; 0.20]

0.13 [0.11 ; 0.16]

  Temporary catheter

5.52 [4.32 ; 6.87]

6.73 [3.75 ; 10.56]

1.96 [1.54 ; 2.45]

2.39 [1.33 ; 3.76]

  Total

0.39 [0.37 ; 0.42]

0.28 [0.24 ; 0.32]

0.21 [0.19 ; 0.23]

0.15 [0.12 ; 0.18]

* Incidence rates for AV fistulas, with and without buttonhole, are limited to data from 2013-2014 and 2014-2015, as information on the use of the buttonhole technique was not collected before 2013-2014.

Figure 4 – VARBSI Incidence Rates by Type of Vascular Access, for Units Participating Since 2010–2011 (N = 28), Québec, 2010–2011 to 2014–2015 (Incidence Rate per 100 Patient-periods)

Figure 4 – VARBSI Incidence Rates by Type of Vascular Access, for Units Participating Since 2010–2011 (N = 28), Québec, 2010–2011 to 2014–2015 (Incidence Rate per 100 Patient-periods)

Despite recommendations to increase the use of fistulas, the proportion of patients who were receiving hemodialysis through a catheter, either temporary or permanent, increased in 2014–2015 compared to 2010–2014. However, the proportion of patients with a temporary catheter, which is the form of vascular access most likely to lead to a VARBSI, decreased significantly (p < 0.01).

Figure 5 – Time Trends in Patient-periods by Type of Vascular Access, for Units Participating Since 2010–2011 (N = 28), Québec, 2010–2011 to 2014–2015

Figure 5 – Time Trends in Patient-periods by Type of Vascular Access, for Units Participating Since 2010–2011 (N = 28), Québec, 2010–2011 to 2014–2015

Table 3 – Breakdown of Patient-periods by Type of Vascular Access, 2010–2014 and 2014–2015 (%)

Type of Vascular Access

Québec (%)

2010–2014

2014–2015

AV fistula
  With buttonhole
  Without buttonhole

40.6
---
---

38.8
9.1
29.7

Graft

4.5

4.6

Permanent catheter

54.2

56.2

Temporary catheter

0.7

0.4

 

 

 

AV fistula or graft

45.1

43.4

Permanent or temporary catheter

54.9

56.6

  Catheterized for < 90 days

  Catheterized for ≥ 90 days

Total (N)

196,307

55,158

Patients who developed a VARBSI were aged between 0 and 95 years, with a median age of 68 years. The vast majority (85%, or 132 cases) of VARBSIs occurred in patients who received their hemodialysis treatment via catheter, even though they represented only 57% of the patient-periods monitored (Figures 2 and 6). For most of the cases that arose in patients receiving their hemodialysis through an AV fistula, the buttonhole technique was used (53%) even though this technique is used among 23% of patients with AV fistula.

Figure 6 – Breakdown of VARBSIs by Type of Vascular Access, Québec, 2014–2015 (N = 156)

Figure 6 – Breakdown of VARBSIs by Type of Vascular Access, Québec, 2014–2015 (N = 156)

Overall, 12% of VARBSI cases resulted in death within 30 days following the onset of bacteriemia. Death occurred in 16% of cases of VARBSI among hospitalized patients (Table 4 and Figure 7), compared with 12% of cases among patients receiving ambulatory care (p > 0.05). A total of 55% of ambulatory patients who developed a VARBSI required hospitalization.

Table 4 – 30-Day Case Fatality, Percentage of Transfers to ICU and Percentage of Hospitalizations and Rehospitalizations During a VARBSI Episode, by Origin of Acquisition, Québec, 2014–2015 (N, %)

Origin of Acquisition

Complication

Number of VARBSI Cases Monitored

Presence of Complication

N

%

During hospitalization

Death within 10 days

19

2

11

 

Death within 30 days

19

3

16

 

Transfer to ICU

19

3

16

 

Rehospitalization

19

1

5

During ambulatory care

Death within 10 days

137

6

4

 

Death within 30 days

137

16

12

 

Transfer to ICU

136

17

13

 

Hospitalization

137

76

55

Figure 7 – 30-Day Case Fatality, Percentage of Transfers to ICU and Percentage of Hospitalizations and Rehospitalizations During a VARBSI Episode, by Origin of Acquisition, Québec, 2014–2015 (%)

Figure 7 – 30-Day Case Fatality, Percentage of Transfers to ICU and Percentage of Hospitalizations and Rehospitalizations During a VARBSI Episode, by Origin of Acquisition, Québec, 2014–2015 (%)

Figure 8 shows that Staphylococcus aureus was the most frequently isolated microorganism in all VARBSI cases (55%). It was followed by coagulase-negative Staphylococcus (CoNS, 14%) and other enterobacteria (other than Escherichia coli and Klebsiella sp., 9%). Six of the CoNS cases (n = 23) were S. lugdunensis and 8 were S. epidermidis. S. aureus was the most frequently isolated microorganism in cases resulting in death (60%).

Figure 8 – Categories of Isolated Microorganisms in All Reported Cases (N = 163) and Cases Resulting in Death Within 30 Days (N = 20), Québec, 2014–2015 (%)

Isolated Microorganisms—All Cases
Figure 8 – Categories of Isolated Microorganisms in All Reported Cases (N = 163) and Cases Resulting in Death Within 30 Days (N = 20), Québec, 2014–2015 (%)

Isolated Microorganisms—Death Within 30 Days
Figure 8 – Categories of Isolated Microorganisms in All Reported Cases (N = 163) and Cases Resulting in Death Within 30 Days (N = 20), Québec, 2014–2015 (%)

In 2014–2015, 15% of S. aureus strains were oxacillin-resistant, which is not significantly different compared with 2010–2014 percentage (Table 5 and Figure 8).

Table 5 – Percentage of Strains Tested and Percentage of Resistance to Antibiotics for Certain Isolated Microorganisms, Québec, 2014–2015 (N, %)

Microorganism

Antibiotic

Isolated

Tested

Resistant

N

N

%

N

%

Staphylococcus aureus

Oxacillin

89

89

100.0

13

14.6

Enterococcus faecium

Vancomycin

2

2

100.0

1

50.0

Enterococcus faecalis

Vancomycin

5

5

100.0

0

0.0

Klebsiella (pneumoniae/oxytoca)

CSE 4

7

4

57.1

2

50.0

Imipenem or meropenem

7

2

28.6

0

0.0

Multiresistant 1

7

5

71.4

2

40.0

Escherichia coli

CSE 4

2

2

100.0

0

0.0

Fluoroquinolones 3

2

2

100.0

1

50.0

Imipenem or meropenem

2

2

100.0

0

0.0

Multiresistant 1

2

2

100.0

0

0.0

Enterobacter sp.

CSE 4

7

6

85.7

0

0.0

Imipenem or meropenem

7

3

42.9

0

0.0

Multiresistant 1

7

7

100.0

0

0.0

Pseudomonas sp.

Amikacin, gentamicin or tobramycin

5

4

80.0

0

0.0

CSE 2

5

5

100.0

0

0.0

Fluoroquinolones 2

5

5

100.0

0

0.0

Imipenem or meropenem

5

3

60.0

0

0.0

Piperacillin/tazobactam

5

2

40.0

0

0.0

Multiresistant 2

5

5

100.0

0

0.0

Acinetobacter sp.

Imipenem or meropenem

0

0

-

0

-

Multiresistant 3

0

0

-

0

-

CSE 2: cefepime or ceftazidime.
CSE 4: cefepime, cefotaxime, ceftazidime or ceftriaxone.
Fluoroquinolones 2: ciprofloxacin or levofloxacin.
Fluoroquinolones 3: ciprofloxacin, levofloxacin or moxifloxacin.
Multiresistant 1: intermediate or resistant to an agent in three of the following five categories: cephalosporins 4, fluoroquinolones 3, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam.
Multiresistant 2: intermediate or resistant to an agent in three of the following five categories: cephalosporins 2, fluoroquinolones 2, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam.
Multiresistant 3: intermediate or resistant to an agent in three of the following six categories: cephalosporins 2, fluoroquinolones 2, aminoglycosides, carbapenems, piperacillin or piperacillin/tazobactam, ampicillin/sulbactam.

Figure 9 – Percentage of Antibiotic Resistance in Certain Gram-Positive Bacteria, Certain Gram-Negative Bacteria and Pseudomonas sp., Québec, 2010–2011 to 2014–2015 (%)

Figure 9 – Percentage of Antibiotic Resistance in Certain Gram-Positive Bacteria, Certain Gram-Negative Bacteria and Pseudomonas sp., Québec, 2010–2011 to 2014–2015 (%)

Figures 10 and 11 show the breakdown of patient-periods monitored in 2014–2015, by type of vascular access and by healthcare facility. In 2014–2015, the percentage of fistulas decreased in 14 healthcare facilities and increased in 9 (Table 6). Seventeen facilities reported a rate of 0 VARBSI per 100 patient-periods, and 4 reported a rate higher than the 90th-percentile mark for 2010–2014 (Figure 12 and Table 7). Facilities with an incidence rate of 0 had small dialysis units of 4 to 12 chairs, except for two bigger units.

Figure 10 – Patient-periods Followed, by Healthcare Facility, Québec, 2014–2015 (%)

Figure 10 – Patient-periods Followed, by Healthcare Facility, Québec, 2014–2015 (%)

Figure 11 – Breakdown of Patient-periods Monitored by Type of Vascular Access and by Healthcare Facility, Québec, 2014–2015 (N)

Figure 11 – Breakdown of Patient-periods Monitored by Type of Vascular Access and by Healthcare Facility, Québec, 2014–2015 (N)

Figure 12 – VARBSI Incidence Rate per Healthcare Facility (2014–2015) and Incidence Rate Percentile (2010–2011 to 2013–2014), Québec, 2014–2015 (Incidence Rate per 100 Patient-periods)

Figure 12 – VARBSI Incidence Rate per Healthcare Facility (2014–2015) and Incidence Rate Percentile (2010–2011 to 2013–2014), Québec, 2014–2015 (Incidence Rate per 100 Patient-periods)

Table 6 – Number of Patient-periods Monitored and Percentage of Fistulas, by Healthcare Facility, Québec, 2010–2014 and 2014–2015 (N, % [95% CI])

Facility

2010-2014

2014-2015

Variations
(p < 0,05)

Patient-periods (n)

% with fistula

Patient-periods (n)

% with fistula

1

HÔPITAL CHARLES LEMOYNE

15,800

47 [46 ; 48]

4,268

34 [32 ; 35]

decrease

3

HÔPITAL ROYAL VICTORIA

7,375

42 [41 ; 43]

1,970

45 [43 ; 48]

increase

4

HÔPITAL NOTRE-DAME DU CHUM

8,868

63 [62 ; 64]

2,689

68 [66 ; 70]

increase

5

HÔPITAL GÉNÉRAL JUIF

7,422

25 [24 ; 26]

2,572

20 [18 ; 21]

decrease

6

L'HÔPITAL DE MONTRÉAL POUR ENFANTS

178

24 [17 ; 30]

49

29 [16 ; 41]

 

7

PAVILLON L'HÔTEL-DIEU DE QUÉBEC

14,458

52 [51 ; 53]

3,877

57 [55 ; 58]

increase

8

PAVILLON MAISONNEUVE/PAVILLON MARCEL-LAMOUREUX

19,080

49 [48 ; 49]

4,935

43 [42 ; 44]

decrease

9

HÔPITAL DU HAUT-RICHELIEU

5,517

44 [42 ; 45]

1,543

47 [44 ; 49]

increase

11

HÔPITAL PIERRE-LE GARDEUR

4,167

44 [43 ; 46]

1,136

39 [36 ; 41]

decrease

12

CENTRE HOSPITALIER UNIVERSITAIRE SAINTE-JUSTINE

240

21 [16 ; 26]

82

10 [3 ; 16]

decrease

14

CENTRE HOSPITALIER RÉGIONAL DE LANAUDIÈRE

4,727

26 [25 ; 27]

1,308

26 [24 ; 29]

 

15

HÔPITAL FLEURIMONT

5,878

32 [31 ; 33]

1,150

32 [29 ; 35]

 

16

HÔPITAL RÉGIONAL DE RIMOUSKI

2,472

59 [57 ; 61]

709

56 [52 ; 60]

 

18

HÔTEL-DIEU DE LÉVIS

4,008

48 [46 ; 49]

1,097

40 [37 ; 43]

decrease

19

HÔPITAL CITÉ DE LA SANTÉ

8,516

68 [67 ; 69]

3,102

63 [61 ; 65]

decrease

20

HÔPITAL DE CHICOUTIMI

3,978

61 [59 ; 62]

967

49 [46 ; 52]

decrease

21

HÔPITAL SAINT-LUC DU CHUM

5,465

62 [60 ; 63]

1,823

59 [57 ; 61]

 

23

HÔTEL-DIEU D'ARTHABASKA

1,338

38 [35 ; 40]

267

33 [27 ; 38]

 

25

HÔPITAL DU SACRÉ-COEUR DE MONTRÉAL

8,475

28 [27 ; 28]

2,563

32 [30 ; 34]

increase

26

HÔPITAL DE VERDUN

6,409

49 [48 ; 51]

1,754

43 [40 ; 45]

decrease

29

HÔPITAL GÉNÉRAL DE MONTRÉAL

6,084

32 [30 ; 33]

1,407

34 [32 ; 37]

 

31

PAVILLON SAINT-JOSEPH

8,192

28 [27 ; 29]

2,157

29 [28 ; 31]

 

35

HÔPITAL HONORÉ-MERCIER

3,014

51 [50 ; 53]

1,229

56 [53 ; 59]

increase

36

HÔPITAL GÉNÉRAL DU LAKESHORE

4,742

39 [37 ; 40]

1,587

33 [31 ; 36]

decrease

37

HÔTEL-DIEU DE SOREL

2,422

54 [52 ; 56]

662

60 [57 ; 64]

increase

40

HÔPITAL DE HULL

9,319

31 [30 ; 31]

2,105

29 [27 ; 31]

 

44

HÔPITAL SAINTE-CROIX

2,014

43 [40 ; 45]

494

38 [34 ; 42]

 

46

HÔPITAL DE GRANBY

1,795

56 [54 ; 58]

714

47 [43 ; 51]

decrease

47

HÔPITAL DE ROUYN-NORANDA

795

65 [62 ; 69]

134

87 [81 ; 92]

increase

48

CENTRE HOSPITALIER DE ST. MARY

4,086

44 [43 ; 46]

1,137

42 [39 ; 45]

 

49

CENTRE DE SANTÉ ET DE SERVICES SOCIAUX MEMPHRÉMAGOG

566

48 [44 ; 52]

195

45 [38 ; 52]

 

51

HÔPITAL DE MANIWAKI

624

36 [32 ; 40]

199

35 [29 ; 42]

 

53

HÔPITAL DE CHANDLER

-

-

103

42 [32 ; 51]

-

58

HÔPITAL DU SUROÎT

4,085

57 [56 ; 59]

1,095

48 [45 ; 51]

decrease

63

HÔPITAL DE SAINT-GEORGES

363

49 [44 ; 54]

213

51 [44 ; 57]

 

65

HÔPITAL ET CLSC DE VAL-D'OR

1,204

51 [49 ; 54]

392

36 [31 ; 41]

decrease

70

CENTRE DE SOINS DE COURTE DURÉE LA SARRE

334

61 [56 ; 66]

110

50 [41 ; 59]

 

72

HÔPITAL ET CENTRE D'HÉBERGEMENT DE SEPT-ÎLES

281

51 [45 ; 56]

153

72 [65 ; 79]

increase

74

HÔPITAL DE DOLBEAU-MISTASSINI

96

42 [32 ; 52]

155

35 [27 ; 42]

 

81

HÔPITAL DE MONT-LAURIER

1,511

49 [47 ; 52]

453

55 [50 ; 59]

 

89

HÔPITAL DE MONTMAGNY

-

-

144

44 [36 ; 52]

-

96

CENTRE DE SANTÉ DE CHIBOUGAMAU

729

37 [34 ; 41]

238

26 [20 ; 32]

decrease

101

HÔPITAL RÉGIONAL DE SAINT-JÉRÔME

9,269

44 [43 ; 45]

2,280

46 [43 ; 48]

 

111

HÔPITAL DE PAPINEAU

-

-

235

34 [28 ; 40]

-

113

HÔPITAL DE THETFORD MINES

411

59 [54 ; 64]

188

60 [53 ; 67]

 

Table 7 – Number of VARBSI Cases and Incidence Rate by Healthcare Facility, and Percentile Ranking, Québec, 2010–2014 and 2014–2015 (Incidence Rate per 100 Patient-periods [95% CI])

Facility

2010-2014*

2014-2015

Number of cases

Mean number of cases
per year

Rate/100 pp

Number of cases

Rate/100 pp

1

HÔPITAL CHARLES LEMOYNE

42

10.5

0.27 [0.19 ; 0.35]

9

0.21 [0.10 ; 0.37]

3

HÔPITAL ROYAL VICTORIA

43

10.8

0.58 [0.42 ; 0.77]

11

0.56 [0.28 ; 0.94]

4

HÔPITAL NOTRE-DAME DU CHUM

39

9.8

0.44 [0.31 ; 0.59]

15

0.56 [0.31 ; 0.88]

5

HÔPITAL GÉNÉRAL JUIF

14

4.7

0.19 [0.10 ; 0.30]

3

0.12 [0.02 ; 0.29]

6

L'HÔPITAL DE MONTRÉAL POUR ENFANTS

1

0.3

0.56 [0.00 ; 2.20]

0

0.00

7

PAVILLON L'HÔTEL-DIEU DE QUÉBEC

57

14.3

0.39 [0.30 ; 0.50]

4

0.10 [0.03 ; 0.23]

8

PAVILLON MAISONNEUVE/PAVILLON MARCEL-LAMOUREUX

85

21.3

0.45 [0.36 ; 0.55]

12

0.24 [0.13 ; 0.40]

9

HÔPITAL DU HAUT-RICHELIEU

34

8.5

0.62 [0.43 ; 0.84]

4

0.26 [0.07 ; 0.58]

11

HÔPITAL PIERRE-LE GARDEUR

22

5.5

0.53 [0.33 ; 0.77]

6

0.53 [0.19 ; 1.04]

12

CENTRE HOSPITALIER UNIVERSITAIRE SAINTE-JUSTINE

12

3.0

5.00 [2.57 ; 8.23]

1

1.22 [0.00 ; 4.78]

14

CENTRE HOSPITALIER RÉGIONAL DE LANAUDIÈRE

15

3.8

0.32 [0.18 ; 0.50]

1

0.08 [0.00 ; 0.30]

15

HÔPITAL FLEURIMONT

26

6.5

0.44 [0.29 ; 0.63]

7

0.61 [0.24 ; 1.14]

16

HÔPITAL RÉGIONAL DE RIMOUSKI

7

1.8

0.28 [0.11 ; 0.53]

0

0.00

18

HÔTEL-DIEU DE LÉVIS

8

2.0

0.20 [0.09 ; 0.36]

0

0.00

19

HÔPITAL CITÉ DE LA SANTÉ

20

6.7

0.23 [0.14 ; 0.35]

8

0.26 [0.11 ; 0.47]

20

HÔPITAL DE CHICOUTIMI

12

3.0

0.30 [0.16 ; 0.50]

3

0.31 [0.06 ; 0.76]

21

HÔPITAL SAINT-LUC DU CHUM

30

10.0

0.55 [0.37 ; 0.76]

2

0.11 [0.01 ; 0.31]

23

HÔTEL-DIEU D'ARTHABASKA

4

1.0

0.30 [0.08 ; 0.66]

0

0.00

25

HÔPITAL DU SACRÉ-COEUR DE MONTRÉAL

43

10.8

0.51 [0.37 ; 0.67]

13

0.51 [0.27 ; 0.82]

26

HÔPITAL DE VERDUN

24

6.0

0.37 [0.24 ; 0.54]

6

0.34 [0.12 ; 0.67]

29

HÔPITAL GÉNÉRAL DE MONTRÉAL

27

6.8

0.44 [0.29 ; 0.63]

10

0.71 [0.34 ; 1.22]

31

PAVILLON SAINT-JOSEPH

27

6.8

0.33 [0.22 ; 0.47]

7

0.32 [0.13 ; 0.61]

35

HÔPITAL HONORÉ-MERCIER

16

5.3

0.53 [0.30 ; 0.82]

0

0.00

36

HÔPITAL GÉNÉRAL DU LAKESHORE

9

2.3

0.19 [0.09 ; 0.33]

3

0.19 [0.04 ; 0.46]

37

HÔTEL-DIEU DE SOREL

13

3.3

0.54 [0.28 ; 0.87]

6

0.91 [0.33 ; 1.78]

40

HÔPITAL DE HULL

32

8.0

0.34 [0.23 ; 0.47]

6

0.29 [0.10 ; 0.56]

44

HÔPITAL SAINTE-CROIX

7

1.8

0.35 [0.14 ; 0.65]

0

0.00

46

HÔPITAL DE GRANBY

6

2.0

0.33 [0.12 ; 0.66]

0

0.00

47

HÔPITAL DE ROUYN-NORANDA

1

0.3

0.13 [0.00 ; 0.49]

0

0.00

48

CENTRE HOSPITALIER DE ST. MARY

9

2.3

0.22 [0.10 ; 0.39]

3

0.26 [0.05 ; 0.65]

49

CENTRE DE SANTÉ ET DE SERVICES SOCIAUX MEMPHRÉMAGOG

1

0.3

0.18 [0.00 ; 0.69]

0

0.00

51

HÔPITAL DE MANIWAKI

3

1.0

0.48 [0.09 ; 1.18]

0

0.00

53

HÔPITAL DE CHANDLER

-

-

-

0

0.00

58

HÔPITAL DU SUROÎT

10

2.5

0.24 [0.12 ; 0.42]

1

0.09 [0.00 ; 0.36]

63

HÔPITAL DE SAINT-GEORGES

1

0.5

0.28 [0.00 ; 1.08]

0

0.00

65

HÔPITAL ET CLSC DE VAL-D'OR

5

1.7

0.42 [0.13 ; 0.86]

4

1.02 [0.27 ; 2.27]

70

CENTRE DE SOINS DE COURTE DURÉE LA SARRE

0

0.0

0.00

0

0.00

72

HÔPITAL ET CENTRE D'HÉBERGEMENT DE SEPT-ÎLES

1

0.3

0.36 [0.00 ; 1.40]

0

0.00

74

HÔPITAL DE DOLBEAU-MISTASSINI

0

0.0

0.00

1

0.65 [0.00 ; 2.53]

81

HÔPITAL DE MONT-LAURIER

2

0.5

0.13 [0.01 ; 0.38]

0

0.00

89

HÔPITAL DE MONTMAGNY

-

-

-

1

0.69 [0.00 ; 2.72]

96

CENTRE DE SANTÉ DE CHIBOUGAMAU

0

0.0

0.00

0

0.00

101

HÔPITAL RÉGIONAL DE SAINT-JÉRÔME

63

15.8

0.68 [0.52 ; 0.86]

7

0.31 [0.12 ; 0.58]

111

HÔPITAL DE PAPINEAU

-

-

-

2

0.85 [0.08 ; 2.44]

113

HÔPITAL DE THETFORD MINES

3

1.5

0.73 [0.14 ; 1.79]

0

0.00

Facility

2010-2014*

2014-2015

Number of cases

Mean number of cases
per year

Rate/100 pp

Number of cases

Rate/100 pp

10th

 

 

0.00

 

0.00

25th

 

 

0.15

 

0.00

50th

 

 

0.34

 

0.19

75th

 

 

0.50

 

0.51

90th

 

 

0.72

 

0.70

* Changes in rates within individual facilities were not subjected to statistical analysis, given the small number of cases involved.

  1. Fistula First. Graphs of Prevalent AV Fistula Use Rates, By Network [online]. http://www.fistulafirst.org/AboutFistulaFirst/FisultaFirstCatheterLastFFCLData.aspx (last consulted: 2013-08-06).
  2. Ayzac, L., Machut, A., Russell, I., et al. Rapport final pour l’année 2011 du réseau de surveillance des infections en hémodialyse – DIALIN. CClin Sud-Est and RAISIN [online]. http://cclin-sudest.chu-lyon.fr/Reseaux/DIALIN/Resultats/rapport_annuel_2011_V2.pdf (last consulted: 2013-08-06).
  3. Patel, P. R., Yi, S. H., Booth, S., et al. Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report. American Journal of Kidney Diseases, Vol. 62, No. 2 (August 2013), p. 322–330.

Comité de surveillance provinciale des infections nosocomiales (SPIN) – bactériémies associées aux accès vasculaires en hémodialyse

Editorial Committee 

Élise Fortin, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Charles Frenette, Centre universitaire de santé McGill

Muleka Ngenda-Muadi, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Mélissa Trudeau, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

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