Department of Nephrology, Dialysis, and Kidney Transplant; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina.
Department of General Surgery; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina.
Arch Argent Pediatr. 2024 Aug 1;122(4):e202310259. doi: 10.5546/aap.2023-10259.eng. Epub 2024 Mar 14.
Introduction. Central venous catheter (CVC)-related infection is the main complication observed in patients undergoing hemodialysis with this type of venous access. Objective. To estimate the incidence of non-tunneled CVC-related bacteremia, analyze the frequency of causative agents, and explore associated risk factors in children undergoing hemodialysis. Population and methods. Retrospective study in children receiving hemodialysis via a non-tunneled CVC between June 1st, 2015 and June 30th, 2019. A logistic regression was carried out to assess risk factors that were predictors of CVC-related bacteremia. Independent risk factors were described as odds ratios with their corresponding 95% confidence interval (CI). A value of p < 0.05 was considered statistically significant. Results. A total of 121 non-tunneled CVCs were included in this study. The incidence of bacteremia was 3.15 per 1000 catheter-days. The most commonly isolated microorganism was Staphylococcus epidermidis (16 cases, 51.5%). Prior catheter infection was the only independent risk factor for the development of bacteremia associated with non-tunneled CVC (OR: 2.84, 95% CI: 1.01-7.96, p = 0.04). Conclusions. Prolonged use of non-tunneled CVCs for chronic hemodialysis was associated with a low incidence of bacteremia. Gram-positive microorganisms prevailed among causative agents. A prior CVC infection almost trebled the risk for CVC-related bacteremia in our pediatric population receiving hemodialysis.
引言。中心静脉导管（CVC）相关感染是此类静脉通路行血液透析患者观察到的主要并发症。目的。评估非隧道式 CVC 相关菌血症的发生率，分析病原体的频率，并探讨儿童血液透析患者的相关危险因素。人群和方法。对 2015 年 6 月 1 日至 2019 年 6 月 30 日期间接受非隧道式 CVC 血液透析的儿童进行回顾性研究。使用逻辑回归分析评估预测 CVC 相关菌血症的危险因素。将独立危险因素描述为比值比及其相应的 95%置信区间（CI）。p 值<0.05 被认为具有统计学意义。结果。本研究共纳入 121 例非隧道式 CVC。菌血症的发生率为每 1000 导管日 3.15 例。最常分离到的微生物是表皮葡萄球菌（16 例，51.5%）。导管感染史是与非隧道式 CVC 相关菌血症发生的唯一独立危险因素（OR：2.84，95%CI：1.01-7.96，p=0.04）。结论。慢性血液透析患者长时间使用非隧道式 CVC 与菌血症发生率低相关。阳性菌在病原体中占优势。在接受血液透析的儿科人群中，先前的 CVC 感染使 CVC 相关菌血症的风险增加近两倍。
