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Pediatric Nephrology

, Volume 33, Issue 6, pp 1029–1035 | Cite as

Exit site and tunnel infections in children on chronic peritoneal dialysis: findings from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative

  • Sarah J. Swartz
  • Alicia Neu
  • Amy Skversky Mason
  • Troy Richardson
  • Jonathan Rodean
  • John Lawlor
  • Bradley Warady
  • Michael J.G. Somers
Original Article

Abstract

Background

The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a quality improvement initiative to reduce dialysis-associated infections. The frequency of peritoneal dialysis (PD) catheter exit site infection (ESI) and variables influencing its development and end result are unclear. We sought to determine ESI rates, to elucidate the epidemiology, risk factors, and outcomes for ESI, and to assess for association between provider compliance with care bundles and ESI risk.

Methods

We reviewed demographic, dialysis and ESI data, and care bundle adherence and outcomes for SCOPE enrollees from October 2011 to September 2014. ESI involved only the exit site, only the subcutaneous catheter tunnel, or both.

Results

A total of 857 catheter insertions occurred in 734 children over 10,110 cumulative months of PD provided to these children. During this period 207 ESIs arose in 124 children or 0.25 ESIs per dialysis year. Median time to ESI was 392 days, with 69% of ESIs involving exit site only, 23% involving the tunnel only, and 8% involving both sites. Peritonitis developed in 6%. ESI incidence was associated with age (p = 0.003), being the lowest in children aged < 2 years and highest in those aged 6–12 years, and with no documented review of site care or an exit site score  of > 0 at prior month’s visit (p < 0.001). Gender, race, end stage renal disease etiology, exit site orientation, catheter cuff number or mobilization, and presence of G-tube, stoma, or vesicostomy were unassociated with ESI incidence. Of the ESIs reported, 71% resolved with treatment, 24% required hospitalization, and 9% required catheter removal, generally secondary to tunnel infection.

Conclusions

Exit site infections occur at an annualized rate of 0.25, typically well into the dialysis course. Younger patient age and documented review of site care are associated with lower ESI rates. Although most ESIs resolve, hospitalization is frequent, and tunnel involvement/catheter loss complicate outcomes.

Keywords

Exit site infection Tunnel infection Peritoneal dialysis Children 

Notes

Compliance with ethical standards

The SCOPE Consortium and its participating centers follow the Declaration of Helsinki. The SCOPE protocol was approved by an Institutional Review Board (IRB) at each center, unless a center’s IRB determined that such review was unnecessary. Informed consent was obtained on each participant in those institutions with IRB-required consent.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© IPNA 2018

Authors and Affiliations

  • Sarah J. Swartz
    • 1
  • Alicia Neu
    • 2
  • Amy Skversky Mason
    • 3
  • Troy Richardson
    • 4
  • Jonathan Rodean
    • 4
  • John Lawlor
    • 4
  • Bradley Warady
    • 5
  • Michael J.G. Somers
    • 6
  1. 1.Division of Pediatric NephrologyTexas Children’s HospitalHoustonUSA
  2. 2.Division of Pediatric NephrologyJohns Hopkins Children’s CenterBaltimoreUSA
  3. 3.Pharmaceuticals DivisionBayer PharmaceuticalsBerlinGermany
  4. 4.Children’s Hospital AssociationLenexaUSA
  5. 5.Division of Pediatric NephrologyChildren’s Mercy Kansas CityKansas CityUSA
  6. 6.Division of NephrologyBoston Children’s HospitalBostonUSA

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