TY - JOUR
T1 - Epidemiology and Risk Factors for Hemodialysis Access–Associated Infections in Children
T2 - A Prospective Cohort Study From the SCOPE Collaborative
AU - Ruebner, Rebecca L.
AU - De Souza, Heidi Gruhler
AU - Richardson, Troy
AU - Bedri, Badreldin
AU - Marsenic, Olivera
AU - Iorember, Franca
AU - Warejko, Jillian K.
AU - Warady, Bradley A.
AU - Neu, Alicia M.
N1 - Funding Information:
Rebecca L. Ruebner, MD, MSCE, Heidi Gruhler De Souza, MPH, Troy Richardson, PhD, Badreldin Bedri, MD, Olivera Marsenic, MD, Franca Iorember, MD, MPH, Jillian K. Warejko, MD, Bradley A. Warady, MD, and Alicia M. Neu, MD. Research idea and study design: RLR, HGDS, TR, BAW, AMN; data analysis/interpretation: RLR, HGDS, TR, BB, OM, FI, JKW, BW, AMN; statistical analysis: HGDS, TR; supervision or mentorship: BAW, AMN. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. There was no funding for this study. The authors declare that they have no relevant financial interests. SCOPE partners with the US Centers for Disease Control and Prevention's Making Dialysis Safer for Patients Coalition and the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). We would like to acknowledge all of the patients, families, and teams from the SCOPE participating centers, including the following site leads: Michael Somers, MD, Theresa Pak, DNP, MPH, RN, CNN (Boston Children's Hospital); Donna J. Claes, MD, MS, Kayla Hackney, BSN, RN, CDN, CPN (Cincinnati Children's Hospital); Arianna Bowie, BSN, RN, CPN (Phoenix Children's Hospital); Anne Beck, MD, Ann Freihoff, APRN, CPNP (Cardinal Glennon Children's Hospital); Marsha May Lee, MD, Audrey Anaya, MS, RN, CNN (UCSF Benioff Children's Hospital); Mahima Keswani, MD, D. Ian Taylor, BSN, RN (Lurie Children's Hospital); Alison Hewitt Torres, CRNP (Johns Hopkins Hospital); Kathleen Mallett, MSN, APRN, FNP-C, CNN-NP, FNKF (Children's Mercy Kansas City); Raymond Quigley, MD, Haridas Thankappan, MBA, BSN, RN, CNN, CPHQ (Children's Medical Center Dallas); Michelle N. Rheault, MD, Caprice Vanderkolk, RN, MS, NE-BC (University of Minnesota Children's Hospital); Sahar Fathallah-Shaykh, MD, Cynthia Rogers, BSN, RN, CDN (Children's of Alabama); Raj Munshi, MD, Emiliah Kambarami-Sithole, DHA, BSN, RN (Seattle Children's Hospital); Jillian K. Warejko, MD (Yale Children's Hospital); Shefali Mahesh, MD, MBA (Akron Children's Hospital); Rajasree Sreedharan, MD, Jacqueline Dake, APNP (Children's Hospital Wisconsin); Beth A. Vogt, MD, Amy L. Grady, RN, BSN (Nationwide Children's Hospital); Kevin T. Barton, MD, Monica Hughey, RN, BSN (St. Louis Children's Hospital); Marva Moxey-Mims, MD, Diane Kraynak, CPNP, CNN (Children's National Medical Center); Brendan Crawford, MD, Cassie Medlock, BSN, RN, CNN (Arkansas Children's Hospital); Pascale H. Lane, MD, Kristi Booker, MSN, RN, CDN (Oklahoma Children's Hospital); Raoul D. Nelson, MD, PhD, Dan Hansgen, RN, CNN (Primary Children's Hospital); Raed Bou-Matar, MD, Alison Schoch, MSN, APRN, CPNP, CPN (Cleveland Clinic); Sarah J. Swartz, MD, Pamela Heise, MSN, RN, BBA, CPN, CNN (Texas Children's Hospital); Karen A. Ravin, MD, Kimberly A. LaSalvia, MSN, RN, CNN (Dupont Children's Hospital); Laura Castellanos-Reyes, MD (Cohen Children's Hospital); Cynthia Wong, MD, Lonisa McCabe, RN, BSN, CNN (Lucille Packard Children's Hospital); Donald J. Weaver, MD, PhD (Levine Children's Hospital); Sherene Mason, MD, MBA, Alyssa Ruddy, RN (Connecticut Children's Hospital); Kartik Pillutla, MD, (Dell Children's Hospital); Samhar I. Al-Akash, MD, Britt M. Stone, RN, BSN, CNN (Driscoll Children's Hospital); Nicole Christin, MD, Sheila J. Coakley, RN, CNN, MSN (Nicklaus Children's Hospital). Received May 11, 2021. Evaluated by 3 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form November 4, 2021.
Publisher Copyright:
© 2022 National Kidney Foundation, Inc.
PY - 2022/8
Y1 - 2022/8
N2 - Rationale & Objective: Infections cause significant morbidity and mortality for children receiving maintenance hemodialysis (HD). The Standardizing Care to Improve Outcomes in Pediatric End-Stage Kidney Disease (SCOPE) Collaborative is a quality-improvement initiative aimed at reducing dialysis-associated infections by implementing standardized care practices. This study describes patient-level risk factors for catheter-associated bloodstream infections (CA-BSIs) and examines the association between dialysis center–level compliance with standardized practices and risk of CA-BSI. Study Design: Prospective cohort study. Setting & Participants: Children enrolled in SCOPE between June 2013 and July 2019. Exposures: Data were collected on patient characteristics and center-level compliance with HD catheter care practices across the study period. Centers were categorized as consistent, dynamic (improved compliance over the study period), or inconsistent performers based on frequency of compliance audit submission and changes in compliance with HD care practices over time. Outcome: CA-BSIs. Analytical Approach: Generalized linear mixed models were used to evaluate (1) patient-level risk factors for CA-BSI and (2) associations between change in center-level compliance and CA-BSIs. Results: The cohort included 1,277 children from 35 pediatric dialysis centers; 1,018 (79.7%) had a catheter and 259 (20.3%) had an arteriovenous fistula or graft. Among children with a catheter, mupirocin use at the catheter exit site was associated with an increased rate of CA-BSIs (rate ratio [RR], 4.45; P = 0.004); the use of no antibiotic agent at the catheter exit site was a risk factor of borderline statistical significance (RR, 1.79; P = 0.05). Overall median compliance with HD catheter care practices was 87.5% (IQR, 77.3%-94.0%). Dynamic performing centers showed a significant decrease in CA-BSI rates over time (from 2.71 to 0.71 per 100 patient-months; RR, 0.98; P < 0.001), whereas no significant change in CA-BSI rates was detected among consistent or inconsistent performers. Limitations: Lack of data on adherence to HD care practices on the individual patient level. Conclusions: Improvement in compliance with standardized HD care practices over time may lead to a reduction in dialysis-associated infections.
AB - Rationale & Objective: Infections cause significant morbidity and mortality for children receiving maintenance hemodialysis (HD). The Standardizing Care to Improve Outcomes in Pediatric End-Stage Kidney Disease (SCOPE) Collaborative is a quality-improvement initiative aimed at reducing dialysis-associated infections by implementing standardized care practices. This study describes patient-level risk factors for catheter-associated bloodstream infections (CA-BSIs) and examines the association between dialysis center–level compliance with standardized practices and risk of CA-BSI. Study Design: Prospective cohort study. Setting & Participants: Children enrolled in SCOPE between June 2013 and July 2019. Exposures: Data were collected on patient characteristics and center-level compliance with HD catheter care practices across the study period. Centers were categorized as consistent, dynamic (improved compliance over the study period), or inconsistent performers based on frequency of compliance audit submission and changes in compliance with HD care practices over time. Outcome: CA-BSIs. Analytical Approach: Generalized linear mixed models were used to evaluate (1) patient-level risk factors for CA-BSI and (2) associations between change in center-level compliance and CA-BSIs. Results: The cohort included 1,277 children from 35 pediatric dialysis centers; 1,018 (79.7%) had a catheter and 259 (20.3%) had an arteriovenous fistula or graft. Among children with a catheter, mupirocin use at the catheter exit site was associated with an increased rate of CA-BSIs (rate ratio [RR], 4.45; P = 0.004); the use of no antibiotic agent at the catheter exit site was a risk factor of borderline statistical significance (RR, 1.79; P = 0.05). Overall median compliance with HD catheter care practices was 87.5% (IQR, 77.3%-94.0%). Dynamic performing centers showed a significant decrease in CA-BSI rates over time (from 2.71 to 0.71 per 100 patient-months; RR, 0.98; P < 0.001), whereas no significant change in CA-BSI rates was detected among consistent or inconsistent performers. Limitations: Lack of data on adherence to HD care practices on the individual patient level. Conclusions: Improvement in compliance with standardized HD care practices over time may lead to a reduction in dialysis-associated infections.
KW - HD access
KW - Hemodialysis (HD)
KW - antimicrobial ointment
KW - best practices
KW - catheter-associated bloodstream infections (CA-BSIs)
KW - children
KW - chronic kidney disease (CKD)
KW - end-stage kidney disease (ESKD)
KW - infection prevention
KW - infectious complication
KW - microbiology
KW - mupirocin
KW - pediatric nephrology
KW - positive blood culture
KW - standardized care
KW - vascular access
UR - http://www.scopus.com/inward/record.url?scp=85127367735&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127367735&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2021.11.008
DO - 10.1053/j.ajkd.2021.11.008
M3 - Article
C2 - 34979159
AN - SCOPUS:85127367735
SN - 0272-6386
VL - 80
SP - 186-195.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -