Hemodialysis catheter related infections in children

Year 2020, Volume: 45 Issue: 4, 1283 - 1290, 27.12.2020

Görkem Şahin , Bahriye Atmış , Engin Melek , Aysun Karabay Bayazıt

Abstract

Purpose: The aim of this study was to determine the rate of catheter-related bloodstream infection (CRBSI), exit site infection, and responsible microorganisms in pediatric hemodialysis patients.
Materials and Methods: In this study, the data of catheter exit site and blood cultures from 12 chronic hemodialysis patients who were followed up during 2015-2017 were retrospectively analyzed.
Results: Twelve pediatric hemodialysis patients in 2015, 2016 and 2017 were hospitalized 127 times for various reasons. Seventeen (13.3%) of these hospitalizations were due to CRBSI or exit site infections. Seven of these patients (58.3%) had both CRBSI and exit site infection, two (16.6%) had exit site infection only, and one (8.3%) had CRBSI. Nine (75%) patients with suspected exit site infection had 22 culture positivity. Microorganisms growing in cultures were Staphylococcus aureus, Staphylococcus epidermidis, Acinetobacter baumannii complex, Enterobacter cloacae, Pseudomonas aeruginosa, and Klebsiella pneumonia, respectively. Nine (75%) patients with suspected CRBSI had 31 culture positivity. Microorganisms growing in cultures were S.aureus, S.epidermidis, E.cloacaa, A.baumannii complex, S.hominis, and P. aeruginosa, respectively.
Conclusion: In children with chronic hemodialysis, CRBSI and/or exit cite infections are seen as common. While CRBSI rate is low alone, the education of the family and the child for the care of catheter should be considered first due to the development of the CRBSI and exit site infection at the same time, or the development of CRBSI following exit site infection.

Keywords

children, hemodialysis, catheter-related infections

Çocuklarda hemodiyaliz kateteri ilişkili enfeksiyonlar

Abstract

Amaç: Bu çalışma ile kronik hemodiyaliz programında olan çocuk hastaların kateter ilişkili kan dolaşım enfeksiyonu (Kİ-KDE), kateter çıkış yeri enfeksiyonu (KÇE) oranlarının ve sorumlu mikroorganizmaların belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmamızda takip edilmekte olan kronik hemodiyaliz tedavisindeki 12 hastanın 2015-2017 yılları arasındaki kateter çıkış yeri kültürleri ve kateterden alınan kan kültürleri verileri retrospektif olarak incelendi.
Bulgular: 2015, 2016 ve 2017 yılları içerisinde takipte olan 12 hemodiyaliz hastası çeşitli nedenler ile 127 kez yatırılarak tedavi edilmişti. Bu yatışların 17’si (%13,3) Kİ-KDE veya KÇE nedeniyleydi. Bu hastalardan yedisinde (%58,3) hem KÇE hem de Kİ-KDE, ikisinde (%16,6) sadece KÇE ve birinde (%8,3) ise sadece Kİ-KDE saptandı. KÇE şüphesi taşıyan dokuz (%75) hastada 22 kez üreme saptanmıştı. Kültürlerde üreyen mikroorganizmalar sıklık sırasıyla Staphylococcus aureus, Staphylococcus epidermidis, Acinetobacter baumannii complex, Enterobacter cloacae Pseudomonas aeruginosa ve Klebsiella pneumonia idi. Kİ-KDE şüphesi taşıyan 9 (%75) hastada 31 kez anlamlı üreme saptanmıştı. Kültürlerde üreyen mikroorganizmalar sıklık sırasıyla S.aureus, S.epidermidis, E.cloacae, A.baumannii complex, S.hominis ve P.aeruginosa idi..
Sonuç: Kronik hemodiyaliz yapılan çocuklarda Kİ-KDE ve/veya KÇE sıklıkla görülmektedir. Tek başına Kİ-KDE oranı düşük iken, Kİ-KDE ile KÇE’nin aynı anda veya KÇE’yi takiben Kİ-KDE’nun gelişimi nedeniyle kateterin bakımı için aile ve çocuğun eğitimi ilk sırada göz önünde tutulmalıdır.

Keywords

çocuk, hemodiyaliz, kateter ilişkili enfeksiyonlar

References

• Munshi R, Symons JM. Hemodialysis. In Clinical Pediatric Nephrology Third Edition (Eds KK Kher, HW Schnaper, LA Greenbaum):703-22. Baco Raton, CRC Press, 2017.
• National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for 2006 updates: hemodialysis adequacy, peritoneal dialysis adequacy, and vascular access. Am. J. Kidney Dis. 48(Suppl. 1), S1–S322 (2006).
• Rees L. Hemodialysis in children. In Pediatric Nephrology 7th edition (Eds ED Avner, VE Harmon, P Niaudet, N Yoshikawa, F Emma, SL Goldstein):2433-54. Berlin Heidelberg, Springer-Verlag, 2016.
• Stefanidis CJ. Preventing catheter-related infections in children undergoing hemodialysis. Expert Rev Anti Infect Ther. 2010;8(11):1239-49.
• North American Pediatric Renal Transplant Cooperative Study Annual Report. Renal transplantation, dialysis, chronic renal insufficiency (2008) https://web.emmes.com/study/ped/ annlrept/Annual%20Report%20-2008.pdf
• O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51(RR-10):1-29.
• Allon M. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004;44:779-91.
• Katneni R, Hedayati SS. Central venous catheter related bacteremia in chronic hemodialysis patients: epidemiology and evidence based management. Nat Clin Pract Nephrol. 2007;3(5):256-66.
• Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. 2001;60(4):1443-51.
• Dopirak M, Hill C, Oleksiw M, Dumigan D, Arvai J, English E et al. Surveillance of hemodialysis-associated primary bloodstream infections: the experience of ten hospital-based centers. Infect Control Hosp Epidemiol. 2002;23(12):721-4.
• Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int. 2011;79(6):587-98.
• Shingarev R, Barker-Finkel J, Allon M. Natural history of tunneled dialysis catheters placed for hemodialysis initiation. J Vasc Interv Radiol. 2013;24:1289-94.
• Yap HY, Pang SC, Tan CS, Tan YL, Goh N, Achudan S et al. Catheter-related complications and survival among incident hemodialysis patients in Singapore. J Vasc Access. 2018;19(6):602-8.
• Inrig JK, Reed SD, Szczech LA, Engemann JJ, Friedman JY, Corey GR et al. Relationship between clinical outcomes and vascular access type among hemodialysis patients with Staphylococcus aureus bacteremia. Clin J Am Soc Nephrol. 2006;1(3):518-24.
• Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M et al Canadian Society of Nephrology Vascular Access Work Group. Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis. 2016;3:2054358116669129.
• Ştefan G, Stancu S, Căpuşă C, Ailioaie OR, Mircescu G. Catheter-related infections in chronic hemodialysis: a clinical and economic perspective. Int Urol Nephrol. 2013;45(3):817-23.
• O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO et al; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-93.
• Böhlke M, Uliano G, Barcellos FC. Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment. J Vasc Access. 2015;16(5):347-55.
• Johnson DW, MacGinley R, Kay TD, Hawley CM, Campbell SB, Isbel NM et al. A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters. Nephrol Dial Transplant. 2002;17(10):1802-7.