1068. Catheter-Related Bloodstream Infections in Pediatric Hemodialysis Patients
Session: Poster Abstract Session: Healthcare-Associated Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

Central vascular catheters (CVCs) are commonly used for vascular access in hemodialysis (HD) patients. We noted that catheter-related blood stream infections (CRBSIs) were a significant cause of hospitalization in children undergoing HD at our institution.

Methods: 

A retrospective chart review of CRBSIs in children on HD at the pediatric dialysis clinic at SUNY Downstate Medical Center. Data including demographic characteristics, types and sites of central venous catheter, duration of catheter use, causative organisms and sensitivities were collected.

Results: 

From January 2009 to April 2011, 25 children, 2-21 yo, were identified; 24/25 were receiving HD via CVCs. A total of 108 catheters were placed, 105 were tunneled: 77 were internal jugular,15 subclavian, and 13 femoral veins,3 were non-tunneled. Mean duration of catheter use was 773 d (range 24-3265 d). CRBSIs developed in 16 (64%) pts for a total of 130 episodes (mean 5/pt, range 1-48/pt) for an incidence of 6.9/1,000 catheter-days. Incidence of BSI with tunneled catheters was 6.6, non-tunneled catheters, 15.3, femoral catheters, 13.9, internal jugular catheters, 6 and subclavian, 6.1/1,000 catheter-days. Coagulase-negative staphylococci were responsible for 47(36.4%) episodes, S. aureus 29(22%), MRSA 8/29 (28%), Gram negative bacilli (Pseudomonas aeruginosa, P. putida, K. pneumoniae, Stenotrophomonas maltophilia), 45 (35%) and Candida spp, 7 (5%). Uncommon organisms responsible for BSI included Delftia acidovorans, Chryseobacterium meningosepticum, Providencia stuartii, Morganella morganii, Neisseria sicca and Bacillus cereus.

Conclusion: 

The incidence of BSI in our pediatric HD patients was higher than the national estimated CRBSI from pediatric and adult patients. Our patients averaged 5 episodes of CRBSI each. In one case repeated episodes lead to removal of child from transplant list due to IVC thrombosis. The incidence in adults undergoing HD with CVCs has been reported to be 1.05 - 5.5/1,000 catheter-days compared to only 0.04 - 0.6 in adults with arterio-venous fistulas (AVF). The National Kidney Foundation Disease Outcomes Quality Initiative recommends decreased use of CVCs for HD. Efforts should be made to use AVF in children undergoing long-term HD.


Subject Category: P. Pediatric and perinatal infections

Kobkul Chotikanatis, M.D.1, Martin Bäcker, MD2, Bandana Paudyal, MD3, Morris Schoeneman, MD3 and Margaret Hammerschlag, MD4, (1)Pediatrics, SUNY Downstate Medical Center, Brooklyn , NY, (2)SUNY Downstate, Brooklyn, NY, (3)Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, (4)SUNY Downstate Medical Center, Brooklyn, NY

Disclosures:

K. Chotikanatis, None

M. Bäcker, None

B. Paudyal, None

M. Schoeneman, None

M. Hammerschlag, None

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