Microbiological Patterns and Outcomes of Catheter-Related Bloodstream Infections in Pediatric Hemodialysis: A 9-Year Retrospective Study at a National Referral Center in Mexico

Background: Catheter-related bloodstream infections (CRBSIs) remain a major contributor to morbidity in children receiving chronic hemodialysis, particularly in Latin American settings where surveillance data are scarce and fragmented. This study provides a comprehensive analysis of CRBSI incidence, microbiological profiles, and clinical outcomes at a national pediatric referral center in Mexico. Methods: A retrospective study including pediatric patients (<18 years) who underwent hemodialysis via central venous catheters (CVCs) from January 2016 to May 2024 was carried out at the Hospital Infantil de Me xico Federico Go mez. Based on CDC diagnostic criteria, confirmed CRBSI episodes were identified. Using descriptive statistics, demographic characteristics, microbiological results, therapeutic regimens, and clinical outcomes were methodically examined. Results: Among 56 pediatric patients, a total of 89 catheter-related bloodstream infection (CRBSI) episodes were identified, resulting in an incidence of 11.6 episodes per 1,000 catheter-days. Staphylococcus aureus (39.3%), Staphylococcus epidermidis (23.6%), Klebsiella pneumoniae (9.0%), and Enterococcus faecalis (4.5%) were the most frequently isolated pathogens. The most affected groups were school-age children (37.1%) and adolescents (40.4%). The most used empirical regimen was vancomycin plus cefepime (58.4%). Catheter removal was required in 36% of episodes. No infection-related deaths were recorded. A substantial decrease in CRBSI incidence was observed from 2021 onwards. Conclusion: The substantial decline in infection rates underscores the effectiveness of targeted preventive strategies, including standardized catheter care protocols, continuous microbiological surveillance, and context-specific therapeutic interventions. These measures have demonstrated a meaningful impact in safeguarding pediatric hemodialysis patients, a population inherently vulnerable to catheter-related complications.