86 - Infectious Complications in Children Undergoing Dialysis

Abstract

In children on peritoneal dialysis (PD) and hemodialysis (HD), infectious complications are a major cause of morbidity and mortality. Infectious complications of PD consist of peritonitis and catheter-related infection. Peritonitis occurs at a rate of 0.42–0.64 episodes per patient year. The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative devised “bundles” for PD care involving catheter insertion, PD training, and follow-up. Treatment for bacterial peritonitis involves intraperitoneal (IP) antibiotics, treatment for fungal peritonitis involves catheter removal and systemic antifungals, and treatment for culture-negative peritonitis involves empiric antibiotics for 2 weeks. PD catheter-related infections consist of exit-site infections (ESIs) and tunnel infections (TIs) and occur at a rate of 0.25 per year of PD. Treatment of ESIs involves oral antibiotics, while treatment of TIs involves oral, intravenous (IV), or IP antibiotics. Infectious complications of HD consist of catheter-associated bloodstream infections (CABSIs) and catheter-related infections. CABSIs occur at a rate of 1.3–10.1 episodes per 1000 catheter days. SCOPE devised “bundles” for HD care involving exit-site assessment, catheter connection/disconnection, cap care, and exit-site care. Treatment for CABSIs involves empiric IV antibiotics. If fever and bacteremia/fungemia resolve within 2–3 days, treatment depends on the organism. If fever and bacteremia/fungemia do not resolve within 2–3 days, catheter removal is recommended. HD catheter-related infections consist of ESIs and TIs and occur at a rate of 6.9–9.6 episodes per 1000 catheter days. ESIs may be treated with topical antibiotics, while TIs require IV antibiotics.