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Risk Factors for and Outcomes of Catheter-Associated Peritonitis in Children: The SCOPE Collaborative.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2016 Sep 07; Vol. 11 (9), pp. 1590-1596. Date of Electronic Publication: 2016 Jun 23. - Publication Year :
- 2016
-
Abstract
- Background and Objectives: The Standardizing Care to Improve Outcomes in Pediatric ESRD Collaborative is a quality improvement initiative that aims to reduce peritoneal dialysis-associated infections in pediatric patients on chronic peritoneal dialysis. Our objectives were to determine whether provider compliance with peritoneal dialysis catheter care bundles was associated with lower risk for infection at the individual patient level and describe the epidemiology, risk factors, and outcomes for peritonitis in the Standardizing Care to Improve Outcomes in Pediatric ESRD Collaborative.<br />Design, Setting, Participants, & Measurements: We collected peritoneal dialysis characteristics, causative organisms, compliance with care bundles, and outcomes in children with peritonitis between October of 2011 and September of 2014. Chi-squared tests, t tests, and generalized linear mixed models were used to assess risk factors for peritonitis.<br />Results: Of 734 children enrolled (54% boys; median age =9 years old; interquartile range, 1-15) from 29 centers, 391 peritonitis episodes occurred among 245 individuals over 10,130 catheter-months. The aggregate annualized peritonitis rate was 0.46 episodes per patient-year. Rates were highest among children ≤2 years old (0.62 episodes per patient-year). Gram-positive peritonitis predominated (37.8%) followed by culture-negative (24.7%), gram-negative (19.5%), and polymicrobial (10.3%) infections; fungal only peritonitis accounted for 7.7% of episodes. Compliance with the follow-up bundle was associated with a lower rate of peritonitis (rate ratio, 0.49; 95% confidence interval, 0.30 to 0.80) in the multivariable model. Upward orientation of the catheter exit site (rate ratio, 4.2; 95% confidence interval, 1.49 to 11.89) and touch contamination (rate ratio, 2.22; 95% confidence interval, 1.44 to 3.34) were also associated with a higher risk of peritonitis. Infection outcomes included resolution with antimicrobial treatment alone in 76.6%, permanent catheter removal in 12.2%, and catheter removal with return to peritoneal dialysis in 6% of episodes.<br />Conclusions: Lower compliance with standardized practices for follow-up peritoneal dialysis catheter care in the Standardizing Care to Improve Outcomes in Pediatric ESRD Collaborative was associated with higher risk of peritonitis. Quality improvement and prevention strategies have the potential to reduce peritoneal dialysis-associated peritonitis.<br /> (Copyright © 2016 by the American Society of Nephrology.)
- Subjects :
- Adolescent
Age Factors
Anti-Infective Agents therapeutic use
Catheter-Related Infections microbiology
Catheterization adverse effects
Catheterization methods
Catheterization standards
Catheters, Indwelling adverse effects
Catheters, Indwelling microbiology
Child
Child, Preschool
Device Removal
Female
Gram-Negative Bacterial Infections epidemiology
Gram-Negative Bacterial Infections therapy
Gram-Positive Bacterial Infections epidemiology
Gram-Positive Bacterial Infections therapy
Humans
Infant
Infant, Newborn
Kidney Failure, Chronic therapy
Male
Mycoses epidemiology
Mycoses therapy
Peritoneal Dialysis adverse effects
Peritonitis microbiology
Peritonitis therapy
Prospective Studies
Risk Factors
United States epidemiology
Young Adult
Catheter-Related Infections epidemiology
Guideline Adherence statistics & numerical data
Patient Care Bundles standards
Peritoneal Dialysis standards
Peritonitis epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 11
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 27340282
- Full Text :
- https://doi.org/10.2215/CJN.02540316