Infectious Complications of Hemodialysis in Children

Infections significantly complicate the care of children on hemodialysis and usually are associated with the use of a hemodialysis catheter for dialysis access. Infections of arteriovenous fistulae and arteriovenous grafts are uncommon, but many children on hemodialysis rely on a catheter, either while permanent access is being created or for long-term access. Catheter exit site infections most often occur independently of catheter-related bloodstream infections and are usually amenable to treatment with increased skin antisepsis and oral antibiotic provision. Tunnel infections can be more complicated and sometimes require surgical intervention and lead to catheter replacement. Catheter-related bloodstream infections are generally caused by skin flora and are often related to contamination of an open dialysis catheter hub during a dialysis treatment. Bacterial colonization of catheters and the development of biofilm also predispose to bloodstream infections. Broad-spectrum antibiotics such as vancomycin and ceftazidime are typically used for empiric antibiotic therapy. Antibiotic locks have been shown to reduce catheter infections and also augment cure rates. Catheter replacement or removal may be necessary, especially with infection with difficult-to-treat organisms or with persistent or recurrent infection.