title: Risk Factors for and Outcomes of Catheter-Associated Peritonitis in Children: The SCOPE Collaborative.
abstract: 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.
  
  
  
  We collected peritoneal dialysis characteristics, causative organisms, compliance with care bundles, and outcomes in children with 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.
  
  
  
  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 rate was 0.46 episodes per patient-year. Rates were highest among children ≤2 years old (0.62 episodes per patient-year). Gram-positive peritonitis predominated (37.8%) followed by culture-negative (24.7%), gram-negative (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.
  
  
  
  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.
authors.affiliation: Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New Hyde Park, New York.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Sethna
authors.affiliation: Division of Pediatric Infectious Diseases, Kosair Children's Hospital, Louisville, Kentucky.
authors.forename: Kristina
authors.initials: K
authors.lastname: Bryant
authors.affiliation: Division of Pediatric Nephrology, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Raj
authors.initials: R
authors.lastname: Munshi
authors.affiliation: Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.affiliation: Children's Hospital Association, Alexandria, Virginia.
authors.forename: Troy
authors.initials: T
authors.lastname: Richardson
authors.affiliation: Children's Hospital Association, Alexandria, Virginia.
authors.forename: John
authors.initials: J
authors.lastname: Lawlor
authors.affiliation: Division of Infectious Diseases, Washington University, St. Louis, Missouri; and.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Division of Pediatric Nephrology, Johns Hopkins Children's Center, Baltimore, Maryland.
authors.forename: Alicia
authors.initials: A
authors.lastname: Neu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002404:Catheterization / Q000009:adverse effects / Q000379:methods / Q000592:standards; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000628:therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D009181:Mycoses / Q000453:epidemiology / Q000628:therapy; D064872:Patient Care Bundles / Q000592:standards*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000592:standards*; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Follow-Up Studies; Humans; Kidney Failure, Chronic; Patient Care Bundles; Quality Improvement; catheter-related infections; children; peritoneal dialysis; peritonitis; renal dialysis; risk factors