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Touch contamination and associated peritonitis in children undergoing maintenance peritoneal dialysis
Rebecca G Same1, Natalie K Grills2, Sreejata Dutta2
1Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA. samer1@chop.edu.
Insights
Touch contaminations are common in children on peritoneal dialysis (PD). Prompt antibiotic treatment after contamination significantly lowers peritonitis risk, improving patient outcomes.
Area of Science:
- Pediatric Nephrology
- Infectious Disease Management
- Dialysis Patient Care
Background:
- Infections are a major cause of morbidity and mortality in pediatric patients undergoing maintenance peritoneal dialysis (PD).
- Touch contamination is a known risk factor for peritonitis, but optimal management strategies remain under-investigated.
Purpose of the Study:
- To evaluate the incidence and management of touch contamination in children receiving maintenance PD.
- To determine the association between touch contamination management and the risk of developing peritonitis.
Main Methods:
- Retrospective cohort study utilizing data from the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative.
- Analysis of reported touch contamination events, prophylactic antibiotic administration, and transfer set changes.
- Multivariable generalized linear mixed modeling to assess risk factors and management outcomes.
Main Results:
- Touch contamination was reported in 32% of 2685 children, with higher rates in younger children and non-Hispanic Black individuals.
- Prophylactic antibiotic administration post-contamination was linked to a reduced peritonitis prevalence (23% vs. 38%).
- Gram-positive and culture-negative organisms were the most common causes of peritonitis associated with touch contamination.
Conclusions:
- Touch contaminations are frequent occurrences in pediatric maintenance PD patients.
- Prophylactic antibiotic use following touch contamination is associated with a decreased risk of peritonitis.
Background:
Infections are a leading cause of hospitalization and death in children receiving maintenance peritoneal dialysis (PD). Touch contamination is an established risk factor for development of peritonitis, but data regarding optimal management of touch contamination are limited.
Methods:
We conducted a retrospective cohort study using data submitted to the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative between 10/1/2011 and 7/31/2025 to evaluate touch contamination in children. Reported touch contamination events and their management, including administration of prophylactic antibiotics and transfer set changes, were evaluated. Univariate and multivariable generalized linear mixed modeling were used to assess relationships between demographic factors and episodes of touch contamination and between management of touch contamination events and temporally associated peritonitis. We also evaluated the microbiology of touch contamination-associated peritonitis and compared it to peritonitis not associated with touch contamination.
Results:
Of 2685 children included, 846 (32%) reported at least one touch contamination. In a multivariable model, younger age and non-Hispanic Black race were associated with increased rates of touch contamination. Administration of prophylactic antibiotics following touch contamination was associated with a lower prevalence of peritonitis (23% vs. 38%). Most episodes of touch contamination-associated peritonitis were Gram-positive (46%) or culture negative (24%).
Conclusions:
Touch contaminations are common in children undergoing maintenance PD. Administration of prophylactic antibiotics following touch contamination is associated with decreased risk of peritonitis.
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