Key takeaways:

• Younger and non-Hispanic Black patients were more likely to experience a touch contamination event.
• Use of prophylactic antibiotics was associated with lower prevalence of peritonitis.

About one-third of children using peritoneal dialysis experienced a touch contamination event, according to study data published in Pediatric Nephrology.

Infections are common among children using PD, often result in hospitalization and are the second most common cause of death, according to Rebecca G. Same, MD, attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia, and colleagues. Infections can be triggered by contact with the sterile portion of the PD catheter, also known as touch contamination.

Data derived from Same RG, et al. Pediatr Nephrol. 2026;doi:10.1007/s00467-026-07455-8.

“Young children may be more likely to touch the sterile portion of their catheter with unclean hands during connection or disconnection, or unintentionally disconnect it altogether,” Same told Healio. “Caregivers may also unintentionally contaminate the PD system as they juggle a complex medical procedure and an active child. For small children who are incontinent and diapered, the PD catheter and the dialysis system may also be near the diaper, which can lead to contamination from urine and stool.”

In a retrospective cohort study, the researchers evaluated touch contamination events in children on PD to explore optimal management.

They reviewed data from 2,685 children (56.9% boys; 46.4% non-Hispanic white) across 57 pediatric dialysis centers enrolled in the the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) Collaborative between 2011 and 2025.

The primary outcomes were the number and factors associated with reported touch contamination events and how these events were managed, including use of prophylactic antibiotics and transfer set changes.

Results showed that 32% of children experienced at least one touch contamination event.

Compared with children younger than 3 years, the mean annualized touch contamination rates were lower for children aged 3 to 12 years (rate ratio = 0.595; 95% CI, 0.49-0.73) and children aged 13 years and older (rate ratio = 0.5; 95% CI, 0.4-0.61). Non-Hispanic Black patients (rate ratio = 1.36; 95% CI, 1.13-1.63) had significantly higher rates of touch contamination compared with non-Hispanic white patients.

Among 1,206 forms submitted for children with only one touch contamination event, prophylactic antibiotics, as recommended by the International Society for Peritoneal Dialysis (ISPD), were used in 91% of cases. Transfer set changes after an event were documented in 76% of cases that mentioned them.

In addition, peritonitis prevalence was lower when clinicians administrated prophylactic antibiotics vs. when they did not (23% vs. 38%). Annualized peritonitis rates were higher for children with an event vs. children without an event, according to the researchers.

“The most common reason that children in our cohort did not receive those prophylactic antibiotics was because the dialysis clinic wasn’t notified of the contamination event,” Same said. “This highlights the importance of training patients and families to recognize touch contamination events and to notify their clinic promptly if an event occurs so their team can determine if antibiotics need to be given.”

Furthermore, most peritonitis-related touch contamination events were gram-positive (46%) or culture negative (24%). These findings support current ISPD recommendations to use cefazolin for prophylaxis in children, according to the researchers.

Overall, touch contamination events occurred in about one-third of children receiving PD, according to the researchers. Use of prophylactic antibiotics after a touch contamination event was linked to a lower risk for peritonitis for children on PD, they wrote.

The findings also highlight questions for future studies, including which prophylactic antibiotics to use, whether there are associations between transfer set changes and risk for peritonitis and barriers to identifying touch contamination events, Same said.

“We should work to identify barriers for patients and caregivers in recognizing touch contaminations when they happen and notifying their dialysis clinics,” she said. “From there, we need to work to implement interventions to address these barriers to ensure children receive prophylaxis when it is needed.”

For more information:

Rebecca G. Same, MD, can be reached at samer1@chop.edu.