Abstract: TH-PO893

Bloodstream Infections in Pediatric Hemodialysis Outpatients: National Healthcare Safety Network, 2013-2015

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Weng, Mark K, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Nguyen, Duc B., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Neu, Alicia, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Apata, Ibironke W., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Patel, Priti R., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
Background

Compared to adults, children on chronic hemodialysis (HD) are more often dialyzed via a central venous catheter (CVC), which poses a high risk of infection. However, data on bloodstream infections (BSIs) in the outpatient pediatric HD population are sparse. To characterize these infections, we analyzed 2013-2015 BSI data that outpatient HD centers reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN), a widely used healthcare-associated infection surveillance system.

Methods

The NHSN dialysis event surveillance protocol defines a BSI as a positive blood culture collected as an outpatient or within 1 calendar day of a hospitalization. Access-related BSIs are positive blood cultures with a suspected vascular access source or uncertain source. Up to 3 organisms per BSI can be reported. Pediatric BSIs were defined as those occurring in patients < 18 years of age at the time of event, and these BSIs could be reported by any participating HD center (adult or pediatric). Events in patients with a calculated age < 1 year were excluded due to data quality concerns. We categorized BSI by highest-risk vascular access type present (CVC > graft > fistula).

Results

During 2013 to 2015, 634 BSIs occurred in pediatric patients > 1 year of age. Of the 634 BSIs, 588 (93%) occurred in patients with CVC; 542 (85%) of the BSIs were classified as access-related. A total of 384 (61%) BSIs resulted in hospitalization, and 10 (2%) resulted in death. The most common pathogens identified were Staphylococcus aureus (30%), coagulase-negative Staphylococci (23%), and Enterococci (8%).

Conclusion

Catheters account for the majority of pediatric HD BSIs reported to NHSN, demonstrating the importance of interventions targeting catheter care and use of permanent vascular access, when possible. Further characterization of the incidence of BSIs in the pediatric outpatient HD population may yield additional opportunities for prevention. A limitation of the analysis is reliance upon calculated age, which may be subject to data entry error.

 . .AGE: 1y to < 5y
[n (%)]
AGE: 5y to < 12y
[n (%)]
AGE: 12y to <18y
[n (%)]
GENDERFemale56 (32)84 (36)115 (51)
HIGHEST-RISK VASCULAR ACCESS TYPECVC
Graft
Fistula
157 (90)
6 (3)
12 (7)
221 (95)
5 (2)
6 (3)
210 (93)
1 (0)
16 (7)
BSI SOURCEVascular access
Other
Contamination
Uncertain
105 (60)
24 (14)
12 (7)
34 (19)
164 (71)
19 (8)
15 (6)
34 (15)
161 (71)
13 (6)
9 (4)
44 (19)
TOTAL BSI 175232227

Funding

  • Other U.S. Government Support