Vascular Access Related infections in Children on regular Hemodialysis: A Single Centre Experience from Egypt
Authors: Moselhy Sawsan Sayed El , Said Ragia Marei Ali , Elhady Marwa Waheed Abd , El-Sharawi Mohamed Nasr , Khamis Mohamed Awad Ibrahim 
Published: November 2024

Abstract

Background
hemodialysis vascular access related infection is a major complication in pediatric patients with end stage renal disease, causing high risk of morbidity and hospitalization. This complication is more commonly reported with non-tunneled hemodialysis catheters and less commonly with arteriovenous fistulae. The Centers for Disease Control and Prevention (CDC) strongly recommends several infection control procedures, including practice of hand hygiene, appropriate catheter care, use of antiseptic agents, checklists, and staff and patient education, all of which are vital to reducing infections

Objective
The aim of this study is to estimate the frequency of vascular access related infections in children on regular hemodialysis and to compare these frequencies in different types of vascular accesses

Material and Methods
This study was conducted on 110 patients with ESRD on hemodialysis from the Pediatric Nephrology unit, Ain Shams University in the period from august 2019 till September 2021. Signs of inflammation; pus formation, redness, or increased swelling at the vascular access site, dialysis events, Hospital admission, positive blood culture were reported. The following measures were also reported from the collected data: bloodstream infection (BSI), local access site infection (LASI) (classified as exit site infection, tunnel infection with hemodialysis catheter or cellulitis with AV fistula), access-related bloodstream infection (ARBSI) and Vascular access infection (VAI).

Results
In the first year, 49 infectious episodes were reported. The most common infectious episodes were reported with non-tunneled catheters 40(81.6%) followed by tunneled catheters 6 (12.2%) and the least with AVF 3 (6.1%). The incidence of infection per 1000 vascular access days in the first year was higher in patients with non-tunneled catheters (10.447 /1000 non tunneled catheter days) which is higher than that seen in patients with tunneled catheters 1.051/1000 tunneled catheter days and in patients with AVF, 0.141/1000 AVF days. In the second year (implementing better infection control procedures), the incidence of infection is lower as follows; 26 infectious episodes were reported. The most common infectious episodes were reported with non-tunneled catheters 21(80.8%) followed by tunneled catheters 4(15.4%) and the least with AVF 1 (3.8%). The incidence of infection per 1000 vascular access days in the second year was higher in patients with non-tunneled catheters (6.861 /1000 non tunneled catheter days) which is higher than that seen in patients with tunneled catheters 0.604 /1000 tunneled catheter days and in patients with AVF, 0.046 /1000 AVF days. Also incidence of hospital admission with VAI per patient – year is less in 2nd year than 1st year being 0.21 and 0.38 admission per patient –year respectively.

Conclusion
the incidence of VAI is more common with non-tunneled catheter than tunneled catheter and the least with AVF so morbidity and mortality are more common in patient with non-tunneled catheter. Implementation of infection control procedure is crucial to decrease risk of VAI and hospitalization.