Hemodialysis catheter-related bacteremia rate is reduced by the use of 0.1% polyhexanide-betaine in a pediatric unit.

Abstract

Background: Infection is one of the main catheter-related complications in children undergoing hemodialysis. Polyhexanide-betaine (PHMB-B) is a broad-spectrum biocide that is especially useful for removing biofilms and improving wound healing. However, there is no evidence regarding its use in routine hemodialysis exit-site care.

Methods: In January 2019, we implemented a new exit site care protocol using PHMB-B over 2% chlorhexidine. The aim of our study was to evaluate the effect of this new protocol on catheter-related bacteremia (CRB) and exit-site infection (ESI) rates. For this, we conducted a retrospective chart analysis of pediatric patients admitted to our hemodialysis unit with tunneled catheters from January 2017 to December 2020, comparing incidence rates before and after protocol implementation. CRB was defined as the presence of infectious symptoms without apparent sources, with defervescence after antibiotic treatment and/or catheter removal, with or without microbiological confirmation. ESI was defined as the presence of purulent discharge with/without skin erythema ⩽2 cm from the exit site.

Results: Twenty children (50% female) aged 4 months-15 years old were admitted to our unit, for a total of 6177 catheter days. After the implementation of our new protocol, the CRB event rate decreased from 2.64 (10 events) to 0.41/1000 catheter-days (1 event; p = 0.041), and the ESI rate decreased from 2.37 (9 events) to 1.25/1000 catheter-days (3 events; ns). No cutaneous adverse reactions or apparent wearing of the catheter material were observed with the use of PHMB-B.

Conclusions: The use of PHMB-B in routine catheter exit site care could be useful in the prevention of catheter-related infectious complications.