Vascular Access Related Infections in Hemodialysis Children and the Impact of Implementation of CDC Guidelines and Tools on the Control of these Infections: A Single Centre Experience from Egypt
DOI:
https://doi.org/10.6000/1929-4247.2024.13.03.7Keywords:
Centers for disease control and prevention, hemodialysis, pediatric, vascular access infectionAbstract
Background: Vascular access-related infection (VARI) is a serious issue in pediatric end-stage kidney disease (ESKD) patients on regular hemodialysis.
Objective: To estimate the frequency of vascular access-related infections in hemodialysis (HD) children and to assess the effect of the implementation of CDC guidelines and tools on the prevention of VARI.
Subjects and Methods: This study was conducted on 110 patients with ESKD on regular hemodialysis at the Pediatric Dialysis Unit, Ain Shams University, from August 2019 to September 2021, retrospectively for one year and prospectively for another year after implementing the CDC infection control procedures.
Besides full history taking, vascular access history, and thorough clinical examination, lab investigations for VARI diagnosis and echocardiography were performed. CDC infection control procedures were implemented for one year, and VARI was re-evaluated.
Results: The total number of patients enrolled in the study was 110, they were 58 males (52.7%) and 52 females (47.3%). The incidence of infection per 1000 vascular access days in both years was highest in patients with NTVCs (10.447 /1000 NTVC days, 6.861 /1000 NTVCs days), followed by patients with TVCs (1.051/1000 TVC days, 0.604 /1000 TVC days) then patients with AVF, (0.141/1000 AVF days, 0.046 /1000 AVF days). The mortality from vascular access-related infections in the first year was higher than in the second year, with 5 patients (10.2%) and 1 patient (3.8%), respectively.
The average duration of hospital stays (PPY) due to VARI (total admission days 8.09 and ward admission days 6.41) in the first year were significantly higher than in the second year, 4.04, 3.20 days/PPY, respectively.
Conclusion: The incidence of vascular access infection (VAI) is higher with non-tunneled catheters and lowest with Arteriovenous fistulae (AVF). To reduce the risk of VARI and hospitalization, proper infection control procedures must be implemented.
References
Shi Y, Tong C, Zhang M, Gao X. Altered functional connectivity density in the brains of hemodialysis end-stage renal disease patients: An in vivo resting-state functional MRI study. PLoS One 2019; 14(12): e0227123. https://doi.org/10.1371/journal.pone.0227123 DOI: https://doi.org/10.1371/journal.pone.0227123
Al-Barshomy SM, El-Antony NG, Sakr M, El Sokary RH. Epidemiology of Central Venous Catheters Infection in Hemodialysis Patients. Egy J Med Microbiol 2021; 82(2): 225-30. https://doi.org/10.21608/ejhm.2021.142815 DOI: https://doi.org/10.21608/ejhm.2021.142815
Patel PR and Brinsley-Rainisch K. The making dialysis safer for patients coalition: a new partnership to prevent hemodialysis-related infections. Clin J Am Soc Nephrol 2018; 13(1): 175-81. https://doi.org/10.2215/CJN.02730317 DOI: https://doi.org/10.2215/CJN.02730317
Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE. North American Vascular Access Consortium. Standardized definitions for hemodialysis vascular access. Semin Dial 2011; (5): 515-24. https://doi.org/10.1111/j.1525-139X.2011.00969.x DOI: https://doi.org/10.1111/j.1525-139X.2011.00969.x
National Kidney Foundation. KDOQI. clinical practice guidelines for Hemodialysis Adequacy. Am J Kidney Dis 2015; 66(5): 884-930. https://doi.org/10.1053/j.ajkd.2015.07.015 DOI: https://doi.org/10.1053/j.ajkd.2015.07.015
Centers for disease control and prevention.Dialysis safety: infection prevention tools 2017. https://www.cdc.gov/dialysis/index.html.
Sethi J, Bagai S, Ramachandran R, Kumar V, Rathi M, Kohli HS., et al.Time to revisit the use of nontunneled dialysis vascular catheters even in cost-limited setting. Indian J Nephrol 2018; 28(5): 406-7. https://doi.org/10.4103/ijn.IJN_443_17 DOI: https://doi.org/10.4103/ijn.IJN_443_17
Bhojaraja MV, Prabhu RA, Nagaraju SP, Ramachandra I.Hemodialysis catheter-related blood stream infections:a single-center experience. J Nephropharmacol 2023;12(2): e10475. https://doi.org/10.34172/npj.2022.10475 DOI: https://doi.org/10.34172/npj.2022.10475
Hasanoglu I, Guner R, Sahin S, et al. Surveillance of hemodialysis related infections: a prospective multicenter study. Sci Rep 2022; 12(1): 22240. https://doi.org/10.1038/s41598-022-24820-3 DOI: https://doi.org/10.1038/s41598-022-24820-3
Mohamed H, Ali A, Browne LD, O'Connell NH, Casserly L, Stack AG, et al. Determinants and outcomes of access-related bloodstream infections among Irish haemodialysis patients; a cohort study. BMC Nephrol 2019; 20(1): 68. https://doi.org/10.1186/s12882-019-1253-x DOI: https://doi.org/10.1186/s12882-019-1253-x
Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors, and pathogens. Journal of infection and public health 2016; 10(4): 403-8. https://doi.org/10.1016/j.jiph.2016.06.008 DOI: https://doi.org/10.1016/j.jiph.2016.06.008
Krzanowski M, Janda K, Chowaniec E, Sułowicz W. Hemodialysis vascular access infection and mortality in maintenance hemodialysis patients. Przegl Lek 2011; 68(12): 1157-61.
Wang K, Wang P, Liang X, Lu X, Liu Z. Epidemiology of haemodialysis catheter complications: a survey of 865 dialysis patients from 14 haemodialysis centres in Henan province in China. BMJ Open 2015; 5(11): e007136. https://doi.org/10.1136/bmjopen-2014-007136 DOI: https://doi.org/10.1136/bmjopen-2014-007136
Weijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant 2004; 19(3): 670-7. https://doi.org/10.1093/ndt/gfg581 DOI: https://doi.org/10.1093/ndt/gfg581
Borzych-Duzalka D, Shroff R, Ariceta G, et al. Vascular access choice, complications, and outcomes in children on maintenance hemodialysis: findings from the International Pediatric Hemodialysis Network (IPHN) Registry. Am J Kidney Dis 2019; 74(2): 193-202. https://doi.org/10.1053/j.ajkd.2019.02.014 DOI: https://doi.org/10.1053/j.ajkd.2019.02.014
Albuquerque SE, Cavalcante Rde S, Ponce D, Fortaleza CM. Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil. Braz J Infect Dis 2014; 18(3): 327-30. https://doi.org/10.1016/j.bjid.2013.10.001 DOI: https://doi.org/10.1016/j.bjid.2013.10.001
Yahia A, Ali MM, Zedan MM, Moemen D. Hemodialysis catheter-related infections among pediatric patients in Mansoura University Children Hospital. Egyptian J Med Microbiol 2022; 31(1): 7-14. https://doi.org/10.21608/ejmm.2022.211924 DOI: https://doi.org/10.21608/ejmm.2022.211924
Kumar G.Catheter-related blood stream infections among children on hemodialysis over 7 years: A single-center experience. Asian J Pediatr Nephrol 2021; 4(1): 22. https://doi.org/10.4103/ajpn.ajpn_31_20 DOI: https://doi.org/10.4103/ajpn.ajpn_31_20
Momeni A, Mardani S, Kabiri M, Amiri M. Comparison of complications of arteriovenous fistula with permanent catheter in hemodialysis patients: a six-month follow-up. Adv Biomed Res 2017; 28(6): 106. https://doi.org/10.4103/2277-9175.213666 DOI: https://doi.org/10.4103/2277-9175.213666
Marsenic O, Rodean J, Richardson T, et al. Tunneled hemodialysis catheter care practices and blood stream infection rate in children: results from the SCOPE collaborative. Pediatr Nephrol 2020; 35(1): 135-43. https://doi.org/10.1007/s00467-019-04384-7 DOI: https://doi.org/10.1007/s00467-019-04384-7
Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2019; 73(3 Suppl 1): A7-A8.
Baracco R, Mattoo T, Jain A, Kapur G, Valentini RP. (Reducing central venous catheters in chronic hemodialysis--a commitment to arteriovenous fistula creation in children. Pediatr Nephrol 2014; 29(10): 2013-20. https://doi.org/10.1007/s00467-013-2744-9 DOI: https://doi.org/10.1007/s00467-013-2744-9
Chotikanatis K, Suman N, Bäcker M, Paudyal B, Schoeneman M, Kohlhoff S, et al. Pediatric Fistula Initiative: reducing bloodstream infections in an outpatient pediatric hemodialysis center. J Pediatric Infect Dis Soc 2015; 4(4): 363-6. https://doi.org/10.1093/jpids/piu053 DOI: https://doi.org/10.1093/jpids/piu053
Sarah HY, Kallen AJ, Hess S, BrenVR, Lincoln ME, Downham G, et al. Sustained infection reduction in outpatient hemodialysis centers participating in a collaborative bloodstream infection prevention effort. Infect Control Hosp Epidemiol 2016; 37(7): 863-6. https://doi.org/10.1017/ice.2016.22 DOI: https://doi.org/10.1017/ice.2016.22
Rayner HC, Pisoni RL, Bommer J, Canaud B, Hecking E, Locatelli F, et al. Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004; 19(1): 108-20. https://doi.org/10.1093/ndt/gfg483 DOI: https://doi.org/10.1093/ndt/gfg483
Molnar AO, Moist L, Klarenbach S, et al. Hospitalizations in dialysis patients in Canada: anational cohort study. Can J Kidney Health Dis 2018; 5: 2054358118780372. https://doi.org/10.1177/2054358118780372 DOI: https://doi.org/10.1177/2054358118780372
Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2016 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2017; 69(3)(suppl 1): S1-S688. https://doi.org/10.1053/j.ajkd.2017.03.001 DOI: https://doi.org/10.1053/j.ajkd.2017.01.036
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
