All parenteral antimicrobials administered to patients requiring chronic hemodialysis in 2 outpatient hemodialysis units over a 12-month period were quantified and assessed for appropriateness based on published guidelines.

A third of patients received at least 1 dose of antimicrobials, and among these, more than half received at least 1 inappropriately indicated dose.

Patients with a tunneled catheter access, a history of colonization or infection with a multidrug-resistant organism, and receiving hemodialysis during daytime shifts were more likely to receive antimicrobials.

Patients with a tunneled catheter access, receiving dialysis in unit B, and with a longer duration of hemodialysis prior to enrollment were at higher risk of receiving an inappropriately indicated antimicrobial dose.

Antimicrobial stewardship efforts in outpatient hemodialysis may focus on minimizing tunneled catheter use, incorporate prior history of multidrug-resistant organisms, and will likely require unit-specific practices.