Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities

Apata, Ibironke W.; Kabbani, Sarah; Neu, Alicia M.; Kear, Tamara M.; D’Agata, Erika M.C.; Levenson, David J.; Kliger, Alan S.; Hicks, Lauri A.; Patel, Priti R.

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.