Risk factors for and outcomes of catheter-associated peritonitis in children: The SCOPE collaborative

SCOPE Investigators

Research output: Contribution to journalArticle

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. Design, setting, participants, & measurements: We collected peritoneal dialysis characteristics, causative organisms, compliance with care bundles, and outcomes in childrenwith 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. 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 ratewas 0.46 episodes per patient-year. Rateswere highestamong children ≤2 years old (0.62 episodes per patient-year). Gram-positive peritonitis predominated (37.8%) followed by culture-negative (24.7%), gramnegative (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. 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.

Original languageEnglish (US)
Pages (from-to)1590-1596
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number9
DOIs
StatePublished - 2016

Fingerprint

Peritonitis
Catheters
Peritoneal Dialysis
Patient Care Bundles
Pediatrics
Chronic Kidney Failure
Confidence Intervals
Quality Improvement
Infection
Touch
Coinfection
Linear Models
Epidemiology

Keywords

  • Catheter-related infections
  • Children
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic
  • Patient Care Bundles
  • Peritoneal dialysis
  • Peritonitis
  • Quality Improvement
  • Renal dialysis
  • Risk factors

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Risk factors for and outcomes of catheter-associated peritonitis in children : The SCOPE collaborative. / SCOPE Investigators.

In: Clinical Journal of the American Society of Nephrology, Vol. 11, No. 9, 2016, p. 1590-1596.

Research output: Contribution to journalArticle

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title = "Risk factors for and outcomes of catheter-associated peritonitis in children: The SCOPE collaborative",
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. Design, setting, participants, & measurements: We collected peritoneal dialysis characteristics, causative organisms, compliance with care bundles, and outcomes in childrenwith 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. 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 ratewas 0.46 episodes per patient-year. Rateswere highestamong children ≤2 years old (0.62 episodes per patient-year). Gram-positive peritonitis predominated (37.8{\%}) followed by culture-negative (24.7{\%}), gramnegative (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. 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.",
keywords = "Catheter-related infections, Children, Follow-Up Studies, Humans, Kidney Failure, Chronic, Patient Care Bundles, Peritoneal dialysis, Peritonitis, Quality Improvement, Renal dialysis, Risk factors",
author = "{SCOPE Investigators} and Sethna, {Christine B.} and Kristina Bryant and Raj Munshi and Warady, {Bradley A.} and Troy Richardson and John Lawlor and Newland, {Jason G.} and Neu, {Alicia M}",
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T1 - Risk factors for and outcomes of catheter-associated peritonitis in children

T2 - The SCOPE collaborative

AU - SCOPE Investigators

AU - Sethna, Christine B.

AU - Bryant, Kristina

AU - Munshi, Raj

AU - Warady, Bradley A.

AU - Richardson, Troy

AU - Lawlor, John

AU - Newland, Jason G.

AU - Neu, Alicia M

PY - 2016

Y1 - 2016

N2 - 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. Design, setting, participants, & measurements: We collected peritoneal dialysis characteristics, causative organisms, compliance with care bundles, and outcomes in childrenwith 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. 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 ratewas 0.46 episodes per patient-year. Rateswere highestamong children ≤2 years old (0.62 episodes per patient-year). Gram-positive peritonitis predominated (37.8%) followed by culture-negative (24.7%), gramnegative (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. 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.

AB - 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. Design, setting, participants, & measurements: We collected peritoneal dialysis characteristics, causative organisms, compliance with care bundles, and outcomes in childrenwith 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. 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 ratewas 0.46 episodes per patient-year. Rateswere highestamong children ≤2 years old (0.62 episodes per patient-year). Gram-positive peritonitis predominated (37.8%) followed by culture-negative (24.7%), gramnegative (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. 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.

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KW - Children

KW - Follow-Up Studies

KW - Humans

KW - Kidney Failure, Chronic

KW - Patient Care Bundles

KW - Peritoneal dialysis

KW - Peritonitis

KW - Quality Improvement

KW - Renal dialysis

KW - Risk factors

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