Vascular access for hemodialysis and catheter-related bloodstream infections: a survey on preventive measures and treatment strategies by the EPDWG and ESPN Dialysis Working Group
Por:
Bakkaloglu, SA, Leventoglu, E, Ezgü, D, Bayrakçi, US, Buder, K, Canpolat, N, Cappoli, A, Cruz, A, Dorresteijn, E, Dönmez, O, Erdogan, H, Göknar, N, Guzzo, I, Bayazit, AK, Lalayiannis, AD, Longo, G, López-Báez, V, Morales-La Madrid A, Mehmood, K, Nalçacioglu, H, Obrycki, L, Parmaksiz, G, Peyronel, F, Printza, N, Roussinov, D, Rus, R, Sallam, DE, Stabouli, S, Szczepanska, M, Tabel, Y, Tasdemir, M, Teixeira, A, Tellier, S, Yildiz, N, Zaloszyc, A, Schmitt, CP, Shroff, R and Edefonti, A
Publicada:
7 ene 2026
Resumen:
The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1% of the centers. Twenty (66.7%) centers reported malfunction as the most common CVC complication, followed by catheter thrombosis (19.4%) and CRBSI (12.9%). The diagnostic approach for CRBSI varied widely, with 35.4% of centers relying on a single positive catheter culture, while 57.9% did not collect a second culture from the peripheral vein or HD circuit. The most common empirical treatment was glycopeptides combined with third-generation cephalosporins. Nearly all centers used intravenous antibiotics for less than 3 weeks, and over half modified lock solutions with antibiotics following CRBSI diagnosis. Catheter removal practices were inconsistent, even in cases of severe infection. Centers reported a total of 548 HD patients. Exit-site infections and CRBSI were observed in 98 (17.8%) and 155 (28.2%) patients, respectively. CRBSI rates and CRBSI-related catheter replacements were significantly higher in centers from countries with HDI < 0.90 and in centers without a dedicated pediatric HD unit. Conclusion: The suboptimal adherence to current VA recommendations and wide variability in catheter care practices including the prevention, diagnosis, and management of CRBSI highlight the need for standardized pediatric-specific protocols to enhance catheter longevity and improve patient outcomes. What is Known: center dot Central venous catheters are widely used in pediatric hemodialysis but carry a high risk of complications, especially catheter-related bloodstream infections (CRBSI). What is New: center dot This multinational survey reveals significant variability in vascular access selection, CRBSI prevention, diagnosis, and treatment across European pediatric hemodialysis centers, with clear disparities by national HDI levels. center dot The findings highlight the need for standardization of vascular access care and CRBSI management and evidence-based pediatric-specific guidelines.
Filiaciones:
Bakkaloglu, SA:
Gazi Univ, Fac Med, Dept Pediat Nephrol, Ankara, Turkiye
Leventoglu, E:
Konya City Hosp, Dept Pediat Nephrol, Konya, Turkiye
Ezgü, D:
Baskent Univ, Fac Med, Ankara, Turkiye
Bayrakçi, US:
Bilkent City Hosp, Dept Pediat Nephrol, Ankara, Turkiye
Buder, K:
Univ Childrens Hosp Zurich, Dept Pediat Nephrol, Zurich, Switzerland
Canpolat, N:
Istanbul Univ Cerrahpasa, Cerrahpasa Fac Med, Dept Pediat Nephrol, Istanbul, Turkiye
Cappoli, A:
IRCCS, Dept Nephrol, Bambino Gesu Childrens Hosp, Rome, Italy
Cruz, A:
Univ Hosp Vall dHebron, Dept Pediat Nephrol, Barcelona, Spain
Dorresteijn, E:
Erasmus MC, Sophia Childrens Univ Hosp, Dept Pediat Nephrol, Rotterdam, Netherlands
Dönmez, O:
Uludag Univ, Fac Med, Dept Pediat Nephrol, Bursa, Turkiye
Erdogan, H:
Bursa City Hosp, Dept Pediat Nephrol, Bursa, Turkiye
Göknar, N:
Istanbul Medeniyet Univ, Fac Med, Dept Pediat Nephrol, Istanbul, Turkiye
Guzzo, I:
IRCCS, Dept Nephrol, Bambino Gesu Childrens Hosp, Rome, Italy
Bayazit, AK:
Cukurova Univ, Fac Med, Dept Pediat Nephrol, Adana, Turkiye
Lalayiannis, AD:
Birmingham Womens & Childrens Hosp NHS Fdn Trust, Dept Pediat Nephrol, Birmingham, England
Longo, G:
Univ Padua, Dept Pediat Nephrol, Dept Woman & Child Hlth, Dialysis & Transplant Unit, Padua, Italy
:
Germans Trias i Pujol Univ Hosp, Dept Nephrol, Barcelona, Spain
St Joan de Deu Univ Hosp, Dept Pediat Neurol, Barcelona, Spain
Morales-La Madrid A:
St Joan de Deu Univ Hosp, Dept Pediat Neurol, Barcelona, Spain
Mehmood, K:
Mayo Hosp, IPNA Sister Renal Ctr, Children Kidney Ctr, Dept Pediat, Lahore, Pakistan
Nalçacioglu, H:
Ondokuz Mayis Univ, Fac Med, Dept Pediat Nephrol, Samsun, Turkiye
Obrycki, L:
Childrens Mem Hlth Inst, Dept Nephrol Kidney Transplantat & Hypertens, Warsaw, Poland
Parmaksiz, G:
Baskent Univ, Dr Turgut Noyan Training & Res Ctr, Dept Pediat Nephrol, Adana, Turkiye
Peyronel, F:
Meyer Childrens Univ Hosp, Nephrol & Dialysis Unit, Florence, Italy
Printza, N:
Aristotle Univ Thessaloniki, Hippokratio Gen Hosp, Dept Pediat Nephrol 1, Dept Pediat, Thessaloniki, Greece
Roussinov, D:
Med Univ Sofia, Dept Pediat, Nephrol & Hemodialysis Clin, SBAL Pediat Dis, Sofia, Bulgaria
Rus, R:
Univ Ljubljana, Fac Med, Univ Childrens Hosp, Dept Nephrol, Ljubljana, Slovenia
Sallam, DE:
Ain Shams Univ, Fac Med, Dept Pediat & Pediat Nephrol, Cairo, Egypt
Stabouli, S:
Aristotle Univ Thessaloniki, Hippokratio Gen Hosp, Dept Pediat Nephrol 1, Dept Pediat, Thessaloniki, Greece
Szczepanska, M:
Med Univ Silesia, Fac Med Sci Zabrze, Dept Pediat, Katowice, Poland
Tabel, Y:
Inonu Univ, Fac Med, Dept Pediat Nephrol, Malatya, Turkiye
Tasdemir, M:
Istinye Univ, Med Fac, Dept Pediat Nephrol, Istanbul, Turkiye
Teixeira, A:
Ctr Hosp Porto, Ctr Materno Infantil Norte, Porto, Portugal
Tellier, S:
CHU Toulouse, Dept Pediat Nephrol & Rheumatolgy, French Reference Ctr Rare Renal Dis SORARE, Toulouse, France
Yildiz, N:
Marmara Univ, Fac Med, Dept Pediat Nephrol, Istanbul, Turkiye
Zaloszyc, A:
Univ Strasbourg, CHU Strasbourg, Dept Pediat Nephrol, Strasbourg, France
Schmitt, CP:
Heidelberg Univ, Med Fac Heidelberg, Ctr Pediat & Adolescent Med, Dept Pediat Nephrol,Clin 1, Heidelberg, Germany
Shroff, R:
Great Ormond St Hosp Children NHS Fdn Trust, Dept Pediat Nephrol, London, England
Edefonti, A:
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Pediat Nephrol Dialysis & Transplant Unit, Milan, Italy
Green Submitted, Green Published, hybrid
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