Epidemiology and Risk Factors for Hemodialysis Access-Associated Infections in Children: A Prospective Cohort Study...

Area of Science:

• Pediatric Nephrology
• Infectious Disease Prevention
• Quality Improvement in Healthcare

Background:

• Infections, particularly catheter-associated bloodstream infections (CA-BSIs), pose significant risks for children undergoing maintenance hemodialysis (HD).
• The Standardizing Care to Improve Outcomes in Pediatric End-Stage Kidney Disease (SCOPE) Collaborative implemented standardized care practices to reduce dialysis-associated infections.

Purpose of the Study:

• To identify patient-level risk factors associated with CA-BSIs in children receiving maintenance HD.
• To examine the relationship between dialysis center-level compliance with standardized practices and the risk of CA-BSI.

Main Methods:

• A prospective cohort study involving 1,277 children from 35 pediatric dialysis centers between June 2013 and July 2019.
• Data collected on patient characteristics and center-level compliance with HD catheter care practices.
• Generalized linear mixed models were used to analyze patient-level risk factors and the association between center compliance and CA-BSIs.

Main Results:

• Among children with catheters, mupirocin use at the exit site (RR, 4.45; P=0.004) and no antibiotic use (RR, 1.79; P=0.05) were associated with increased CA-BSI rates.
• Centers demonstrating improved compliance over time ('dynamic performers') showed a significant decrease in CA-BSI rates (from 2.71 to 0.71 per 100 patient-months; RR, 0.98; P<0.001).
• No significant change in CA-BSI rates was observed in consistent or inconsistent performing centers.

Conclusions:

• Improvements in adherence to standardized hemodialysis care practices are associated with a reduction in dialysis-associated infections in pediatric patients.
• Targeted interventions focusing on catheter care practices are crucial for minimizing CA-BSI risks in this vulnerable population.