Epidemiology and Risk Factors for Hemodialysis Access–Associated Infections in Children: A Prospective Cohort Study From the SCOPE Collaborative

Ruebner, Rebecca L.; Souza, Heidi Gruhler De; Richardson, Troy; Bedri, Badreldin; Marsenić, Olivera; Iorember, Franca M.; Warejko, Jillian K.; Warady, Bradley A.; Neu, Alicia M.

doi:10.1053/j.ajkd.2021.11.008

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…9 Ruebner et al reported that 80% of children on hemodialysis with catheter-associated infections required hospitalization with 36% requiring catheter removal. 9 Therefore, it is critical to avoid infection in these patients. A recent retrospective review study showed that 40% of ECMO patients required a central venous line within 30 days of decannulation.…”

Section: Discussionmentioning

confidence: 99%

“…8 Infections are one of the major complications in children with hemodialysis catheters that increase morbidity and mortality. 9 Ruebner et al reported that 80% of children on hemodialysis with catheter-associated infections required hospitalization with 36% requiring catheter removal. 9 Therefore, it is critical to avoid infection in these patients.…”

Section: Discussionmentioning

confidence: 99%

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Exchange of Extracorporeal Membrane Oxygenation Cannulas for Hemodialysis Catheters in Children Requiring Renal Replacement Therapy

Cruz-Centeno,

Stewart,

Marlor

et al. 2023

The American Surgeon™

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Background Pediatric patients requiring extracorporeal membrane oxygenation (ECMO) may require renal replacement therapy even after decannulation. However, data regarding transition from ECMO cannulation to a hemodialysis catheter in pediatric patients is not currently available. Methods Patients <18 years old who had an ECMO cannula exchanged for a hemodialysis catheter during decannulation at a tertiary care children’s center from January 2011 to September 2022 were identified. Data was collected from the electronic medical record. Results A total of 10 patients were included. The cohort was predominantly male (80.0%, n = 8) with a median age of 1 day (IQR 1.0, 24.0). All ECMO cannulations were veno-arterial in the right common carotid artery and internal jugular vein. The median time on ECMO was 8.5 days (IQR 6.0, 15.0). One patient had the venous cannula exchanged for a tunneled hemodialysis catheter during decannulation, two were transitioned to peritoneal dialysis, and seven had the temporary hemodialysis catheter converted to a tunneled catheter by Interventional Radiology (when permanent access was required) at a median time of 10 days (IQR 8.0, 12.5). Of these 7 patients, 28.6% (n = 2) developed catheter-associated infection within 30 days of replacement, with one requiring catheter replacement. Transient bloodstream infection occurred in 10.0% (n = 1) within 30 days of ECMO cannula exchange. Conclusion Venous ECMO cannula exchange for a hemodialysis catheter in children requiring renal replacement therapy after decannulation is possible as a bridge to a permanent hemodialysis or peritoneal catheter if renal function does not recover, while supporting vein preservation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Exchange of Extracorporeal Membrane Oxygenation Cannulas for Hemodialysis Catheters in Children Requiring Renal Replacement Therapy

Cruz-Centeno,

Stewart,

Marlor

et al. 2023

The American Surgeon™

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“…aureus and Staph. epidermidis being the predominant organisms identified in these infections ( 2 , 3 , 14 ). In the largest international pediatric hemodialysis cohort, CRBSI occurred in 1.3/1,000 catheter-days, with 63% of pathogens identified as gram positive organisms, and 17% as culture negative ( 2 ).…”

Section: Pathogenesis and Treatment Of Crbsi In Pediatric Hemodialysismentioning

confidence: 98%

“…In the largest international pediatric hemodialysis cohort, CRBSI occurred in 1.3/1,000 catheter-days, with 63% of pathogens identified as gram positive organisms, and 17% as culture negative ( 2 ). In the standardized care to improve outcomes in pediatric ESKD (SCOPE) collaborative study, gram positive organisms were identified in 49.7% of cases, and gram negative organisms in 27.5% ( 3 ). Although less common, fungal pathogens such as Candida albicans also cause these infections.…”

Section: Pathogenesis and Treatment Of Crbsi In Pediatric Hemodialysismentioning

confidence: 99%

“…Of the 404 pediatric patients entered into the registry from December 2012 through September 2017, 73% of them initiated hemodialysis through a CVC ( 2 ). Catheter related blood stream infections (CRBSI) are associated with CVC use and a significant cause of morbidity and mortality in hemodialysis patients ( 3 – 5 ). In its 2014 report, the National Healthcare Safety Network reported that most bloodstream infections (63.0%) and access-related bloodstream infections (69.8%) occurred in hemodialysis patients with a CVC ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients

Blair,

Patil,

Nguyen

et al. 2024

Front. Pediatr.

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The predominant use of intravenous catheters as primary access type in the pediatric hemodialysis population is associated with an increased risk of catheter related blood stream infections. While strict adherence to catheter placement and long-term care guidelines have helped to decrease the incidence of these infections, blood stream infections remain an infection burden in pediatric patients with long term hemodialysis catheters. The formation of biofilms on the surfaces of these catheters has been shown to be a source of microbes causing blood stream infections. One of the strategies for preventing bacterial colonization, inhibiting microbial multiplication, and suppressing the seeding of these microbes from biofilms upon maturation, has been the use of antibiotic-based lock solutions in-between dialysis treatments. Although clinical guidelines for the use of antibiotic lock solutions are yet to be developed, available evidence suggests a beneficial role of antibiotic lock solutions in the management of catheter related blood stream infections. Additionally, a clear understanding of how biofilms are formed and their role in the pathogenesis of catheter related bloodstream infection will facilitate the development of solutions that can prevent biofilm formation and inhibit their multiplication, maturation and seeding into the bloodstream.

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The effects of hospital and dialysis unit characteristics on hospitalizations for access-related complications among children on maintenance dialysis: a European, multicenter, observational, cross-sectional study

et al. 2023

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Epidemiology and Risk Factors for Hemodialysis Access–Associated Infections in Children: A Prospective Cohort Study From the SCOPE Collaborative

Cited by 5 publications

References 32 publications

Exchange of Extracorporeal Membrane Oxygenation Cannulas for Hemodialysis Catheters in Children Requiring Renal Replacement Therapy

Exchange of Extracorporeal Membrane Oxygenation Cannulas for Hemodialysis Catheters in Children Requiring Renal Replacement Therapy

Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients

The effects of hospital and dialysis unit characteristics on hospitalizations for access-related complications among children on maintenance dialysis: a European, multicenter, observational, cross-sectional study

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