Touch contamination and associated peritonitis in children undergoing maintenance peritoneal dialysis

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.