Infection in Critically Ill Pediatric Patients on Continuous Renal Replacement Therapy

Santiago, María José; López‐Herce, Jesús; Vierge, Eva; Castillo, Ana Isabel Corchado; Bustinza, Amaya; Bellón, José María; Sánchez, Amelia; Fernández, Sarah N.

doi:10.5301/ijao.5000587

Cited by 11 publications

(10 citation statements)

References 25 publications

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“…Critically ill patients with AKI treated with KRT are more susceptible to a nosocomial bloodstream infection, most commonly caused by Gram-positive species [ 92 ]. Similar findings were also observed in critically ill children treated with CKRT, demonstrating that more than four days of CKRT increased the risk of infection [ 93 ].…”

Section: Pathophysiology Of Sepsis Following Akisupporting

confidence: 73%

Sepsis and Acute Kidney Injury: A Review Focusing on the Bidirectional Interplay

Chang

Chou

Shiao

2022

IJMS

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Although sepsis and acute kidney injury (AKI) have a bidirectional interplay, the pathophysiological mechanisms between AKI and sepsis are not clarified and worthy of a comprehensive and updated review. The primary pathophysiology of sepsis-associated AKI (SA-AKI) includes inflammatory cascade, macrovascular and microvascular dysfunction, cell cycle arrest, and apoptosis. The pathophysiology of sepsis following AKI contains fluid overload, hyperinflammatory state, immunosuppression, and infection associated with kidney replacement therapy and catheter cannulation. The preventive strategies for SA-AKI are non-specific, mainly focusing on infection control and preventing further kidney insults. On the other hand, the preventive strategies for sepsis following AKI might focus on decreasing some metabolites, cytokines, or molecules harmful to our immunity, supplementing vitamin D3 for its immunomodulation effect, and avoiding fluid overload and unnecessary catheter cannulation. To date, several limitations persistently prohibit the understanding of the bidirectional pathophysiologies. Conducting studies, such as the Kidney Precision Medicine Project, to investigate human kidney tissue and establishing parameters or scores better to determine the occurrence timing of sepsis and AKI and the definition of SA-AKI might be the prospects to unveil the mystery and improve the prognoses of AKI patients.

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Section: Pathophysiology Of Sepsis Following Akisupporting

confidence: 73%

Sepsis and Acute Kidney Injury: A Review Focusing on the Bidirectional Interplay

Chang

Chou

Shiao

2022

IJMS

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“…While the difference in survival did not achieve statistical significance, we observed a trend towards decreased survival rates amongst patients who were immunocompromised. There is very limited pharmacokinetic data in pediatric CRRT, potentially impacting optimal treatment of CRRT patients particularly with antimicrobials, as pediatric CRRT patients are reported to have increased infections [ 42 ]. Further study is warranted to determine if higher infection susceptibility translates to increased morbidity from suboptimal treatment.…”

Section: Discussionmentioning

confidence: 99%

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

et al. 2018

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BackgroundTo evaluate changes in population characteristics and outcomes in a large single-center pediatric patient cohort treated with continuous renal replacement therapy (CRRT) over a 10 year course, coincident with multiple institutional practice changes in CRRT delivery.MethodsA retrospective cohort study with comparative analysis of all patients treated from 2004 to 2013 with CRRT in the neonatal, pediatric, and cardiovascular intensive care units within a free-standing pediatric tertiary care hospital.ResultsThree hundred eleven total patients were identified, 38 of whom received concurrent treatment with extracorporeal membrane oxygenation. 273 patients received CRRT only and were compared in two study eras (2004–2008 n = 129; 2009–2013 n = 144). Across eras, mean patient age decreased (9.2 vs 7.7 years, p = 0.08), and the most common principal diagnosis changed from cardiac to liver disease. There was an increase in patients treated with continuous renal replacement therapy between cohorts for acute kidney injury of multi factorial etiology (44% vs 56%) and a decrease in treated patients with sepsis (21% vs 11%, p = 0.04). There was no significant difference in survival to hospital discharge between eras (47% vs 49%). Improvement in outpatient follow-up after discharge amongst survivors was seen between study eras (33% vs 54%).ConclusionsDespite multiple institutional practice changes in provision of CRRT, few changes were seen regarding patient demographics, diseases treated, indications for therapy, and survival over 10 years at a single tertiary care. Recognition of need for follow-up nephrology care following CRRT is improving. Ongoing assessment of the patient population in a changing landscape of care for critically ill pediatric patients remains important.

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“…In a single center retrospective cohort study, a higher odds of infection in a single center study of 5,000 critically ill children: there was a non-linear increase in risk for sepsis based on AKI severity, with stage 3 AKI patients incurring the greatest risk for sepsis ( 99 ). A small single center study of pediatric patients receiving CRRT also found an association with infection, that occurred a median of 11 days after CRRT initiation ( 101 ).…”

Section: Aki and The Effects On Other Organ Systemsmentioning

confidence: 99%

The Neglected Price of Pediatric Acute Kidney Injury: Non-renal Implications

Pande

Smith

Soranno³

et al. 2022

Front. Pediatr.

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Preclinical models and emerging translational data suggest that acute kidney injury (AKI) has far reaching effects on all other major organ systems in the body. Common in critically ill children and adults, AKI is independently associated with worse short and long term morbidity, as well as mortality, in these vulnerable populations. Evidence exists in adult populations regarding the impact AKI has on life course. Recently, non-renal organ effects of AKI have been highlighted in pediatric AKI survivors. Given the unique pediatric considerations related to somatic growth and neurodevelopmental consequences, pediatric AKI has the potential to fundamentally alter life course outcomes. In this article, we highlight the challenging and complex interplay between AKI and the brain, heart, lungs, immune system, growth, functional status, and longitudinal outcomes. Specifically, we discuss the biologic basis for how AKI may contribute to neurologic injury and neurodevelopment, cardiac dysfunction, acute lung injury, immunoparalysis and increased risk of infections, diminished somatic growth, worsened functional status and health related quality of life, and finally the impact on young adult health and life course outcomes.

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Infection in Critically Ill Pediatric Patients on Continuous Renal Replacement Therapy

Abstract: Infection rate is high in critically ill children treated with CRRT. More than 4 days of CRRT increases the risk of infection. Infection in these patients entails a longer stay in the PICU but did not increase mortality.

Cited by 11 publications

References 25 publications

Sepsis and Acute Kidney Injury: A Review Focusing on the Bidirectional Interplay

Sepsis and Acute Kidney Injury: A Review Focusing on the Bidirectional Interplay

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

The Neglected Price of Pediatric Acute Kidney Injury: Non-renal Implications

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