The cost of hospitalizations for treatment of hemodialysis catheter-associated blood stream infections in children: a retrospective cohort study

Wasik, Heather L.; Neu, Alicia M.; Warady, Bradley A.; Crawford, Brandon L.; Richardson, Troy; Souza, Heidi Gruhler De; Cardwell, Diana; Ruebner, Rebecca L.

doi:10.1007/s00467-022-05764-2

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…In 2022, the SCOPE Collaborative analyzed the scal implications of a CA-BSI in children receiving HD and found that, on average, each CA-BSI resulting in hospitalization incurred an average cost of $18,375. Hospitalizations that required a longer stay or ICU care were associated with a signi cantly higher average cost [2].…”

Section: Introductionmentioning

confidence: 99%

Use of ClearGuard HD caps in pediatric hemodialysis patients

Nau,

Richardson,

Cardwell

et al. 2024

Pediatr Nephrol

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Background Bloodstream infections (BSIs) are a leading cause of hospitalizations and mortality among patients receiving hemodialysis (HD) therapy, especially those with a central venous catheter (CVC) for dialysis access. The use of chlorhexidine impregnated catheter caps (ClearGuard) has been associated with a decrease in the rate of HD catheter-related BSIs (CA-BSIs) in adults; similar data have not been published for children. Methods We compared CA-BSI data from participating centers within the Standardizing Care to Improve Outcomes in Pediatric Endstage Kidney Disease (SCOPE) collaborative based on the center’s use of ClearGuard caps for patients with HD catheter access. Centers were characterized as ClearGuard (CG) or non-ClearGuard (NCG) centers, with CA-BSI data pre- and post-CG implementation reviewed. All positive blood cultures in participating centers were reported to the SCOPE collaborative and adjudicated by an infectious disease physician. Results Data were available from 1786 SCOPE enrollment forms completed January 2016–January 2022. January 2020 served as the implementation date for analyzing CG versus NCG center data, with this being the time when the last CG center underwent implementation. Post January 2020, there was a greater decrease in the rate of HD CA-BSI in CG centers versus NCG centers, with a decrease from 1.18 to 0.23 and 0.41 episodes per 100 patient months for the CG and NCG centers, respectively (p = 0.002). Conclusions Routine use of ClearGuard caps in pediatric dialysis centers was associated with a reduction of HD CA-BSI rates in pediatric HD patients. Graphical abstract

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Section: Introductionmentioning

confidence: 99%

Use of ClearGuard HD caps in pediatric hemodialysis patients

Nau,

Richardson,

Cardwell

et al. 2024

Pediatr Nephrol

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“…2 For example, a study in children who received hemodialysis reported the mean cost for hemodialysis CRBSI was $18,375 ($11,584-36,266), along with longer length of stay, and additional catheter procedures. 83,84 In a study, the incidence of CRBSI was 0.67 episodes per 1000 catheter days. 85 This accounted for 23% of the cases of hospitalization with TCVC and 5.2% of total hospitalization costs.…”

Section: Economics Considerationmentioning

confidence: 99%

Taurolidine and Heparin as Catheter Lock Solution for Central Venous Catheters in Hemodialysis

Nguyen,

Camins,

Butler

2024

American Journal of Therapeutics

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Background: Chronic kidney disease can lead to end-stage renal disease, and the prevalence is increasing. Many patients starting hemodialysis require central venous catheters (CVCs). Catheter-related bloodstream infections (CRBSIs) are a common complication and lead to significant morbidity and mortality. Interventions to prevent CRBSI include antimicrobial lock therapy but concern for the development of antimicrobial resistance and adverse effects. Nonantimicrobial antiseptics as catheter lock solutions have also been used. Taurolidine and heparin catheter lock solution is first approved by the Food and Drug Administration for the prevention of CRBSI in patients on hemodialysis. Taurolidine has a unique mechanism of action and favorable safety profile. Mechanism of Action, Pharmacodynamics, and Pharmacokinetics: Taurolidine and heparin catheter lock solution have both antimicrobial and anticoagulant properties. Taurolidine is derivative of the amino acid taurine, and heparin is derived from porcine intestinal mucosa. Taurolidine not only damages microbial cell walls but also prevents the adherence of microorganisms to biological surfaces, preventing biofilm formation. Taurolidine and heparin catheter lock solution is intended to be used intraluminally within the catheter and should be aspirated. Because it is used locally, limited pharmacokinetic and pharmacodynamic data are available. Clinical Trials: The LOCK-IT-100 trial is a randomized, double-blind, phase 3 study, which included 795 end-stage renal disease patients on hemodialysis with CVC. Taurolidine and heparin was compared with the control heparin alone. The results of the study showed a 71% risk reduction in CRBSI for taurolidine and heparin arm (95% confident interval, 38%–86%, P = 0.0006). Other studies have also shown that taurolidine lock solution leads to decreased CRBSI episodes. Several systematic reviews and meta-analysis consisted of taurolidine in adult, and pediatric populations also showed reduction in the incidence of CRBSIs. Therapeutic Advance: Taurolidine and heparin lock solution represents a novel preventive strategy for those undergoing hemodialysis through a CVC by reducing the risk of CRBSI. This is significant progress because there are no other similar options available for patients for whom catheters are the only options for their life-saving treatment.

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“…In its 2014 report, the National Healthcare Safety Network reported that most bloodstream infections (63.0%) and access-related bloodstream infections (69.8%) occurred in hemodialysis patients with a CVC (5). The cost of ambulatory care of CRBSI, and hospitalization of pediatric hemodialysis patients with CRBSI is substantial, ranging between $11,584-36,266 per patient, with higher costs in patients needing intensive care unit stay and CVC replacement (6,7). Microbial colonization and biofilm formation on the surface of CVC occurs frequently in hemodialysis patients dialyzed through CVC, and has been identified as a source of the microorganisms causing CRBSI (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients

Blair,

Patil,

Nguyen

et al. 2024

Front. Pediatr.

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The predominant use of intravenous catheters as primary access type in the pediatric hemodialysis population is associated with an increased risk of catheter related blood stream infections. While strict adherence to catheter placement and long-term care guidelines have helped to decrease the incidence of these infections, blood stream infections remain an infection burden in pediatric patients with long term hemodialysis catheters. The formation of biofilms on the surfaces of these catheters has been shown to be a source of microbes causing blood stream infections. One of the strategies for preventing bacterial colonization, inhibiting microbial multiplication, and suppressing the seeding of these microbes from biofilms upon maturation, has been the use of antibiotic-based lock solutions in-between dialysis treatments. Although clinical guidelines for the use of antibiotic lock solutions are yet to be developed, available evidence suggests a beneficial role of antibiotic lock solutions in the management of catheter related blood stream infections. Additionally, a clear understanding of how biofilms are formed and their role in the pathogenesis of catheter related bloodstream infection will facilitate the development of solutions that can prevent biofilm formation and inhibit their multiplication, maturation and seeding into the bloodstream.

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The cost of hospitalizations for treatment of hemodialysis catheter-associated blood stream infections in children: a retrospective cohort study

Cited by 5 publications

References 25 publications

Use of ClearGuard HD caps in pediatric hemodialysis patients

Use of ClearGuard HD caps in pediatric hemodialysis patients

Taurolidine and Heparin as Catheter Lock Solution for Central Venous Catheters in Hemodialysis

Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients

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