A Retrospective Study of Central Line-Associated Bloodstream Infections in Children Treated With Hemodialysis in a Tertiary Care Center

Abstract

Background Central venous catheter (CVC) poses a significant risk of infectious complications in children undergoing hemodialysis. A major concern is the occurrence of central line-associated bloodstream infections (CLABSIs), which are most critical and lead to significant morbidity. Methods We conducted a study in our pediatric hemodialysis center in King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. We included pediatric patients (younger than 14 years old) with a positive central line blood culture who underwent hemodialysis from 2015 until 2023. We collected data pertaining to age, sex, underlying disease, clinical manifestations, and microbiological features, as well as their management strategies. We compared this group's epidemiological and biochemical markers to a group of hemodialysis patients who did not develop CLABSI. Results In our pediatric hemodialysis center, we have an overall incidence of 4.2 CLABSIs per 1,000 catheter days, with mainly gram-positive organisms. We found that more than half of the patients required hospitalization, indicating a lower threshold for admission in pediatric patients than adults. We also found that patients with catheter infections had higher white blood cell counts as well as neutrophils, which can be used to raise suspicion of catheter infection. Most patients (85%) did not require catheter removal and were treated with intravenous antibiotics only. Conclusion CLABSIs cause high morbidity and mortality; therefore, clinicians should have a high index of suspicion, especially in patients with fever and a high white blood cell count. Such patients require intravenous antibiotics, lock therapy in some cases, and, occasionally, catheter removal/replacement as indicated.