Telehealth survey of providers and caregivers of children on peritoneal dialysis during the COVID-19 pandemic.

BACKGROUND: There has been growing support for the adoption of telehealth (TH) services in pediatric populations. Children on chronic peritoneal dialysis (PD) represent a vulnerable population that could benefit from increased use of TH. The COVID-19 pandemic prompted rapid adoption of TH services in the population among pediatric centers participating in The Children's Hospital Association's Standardizing Care to Improve Outcomes in Pediatric ESKD (SCOPE) Collaborative. METHODS: We developed a survey to explore the experience of both pediatric PD providers and caregivers of patients receiving PD care at home and using TH services during the COVID-19 pandemic. RESULTS: We obtained responses from 27 out of 53 (50.9%) SCOPE centers that included 175 completed surveys from providers and caregivers. Major challenges identified by providers included inadequate/lack of physical exam, inability to visit with the patient/family in-person, and inadequate/lack of PD catheter exit site exam. Only 51% of caregivers desired future TH visits; however, major benefits of TH for caregivers included no travel, visit takes less time, easier to care for other children, more comfortable for patient, and no time off from work. Providers and caregivers agreed that PD TH visits are family centered (p = 0.296), with the lack of a physical exam (p < 0.001) and the inability to meet in-person (p = 0.002) deemed particularly important to caregivers and providers, respectively. CONCLUSIONS: TH is a productive and viable visit option for children on PD; however, making this a successful, permanent part of routine care will require an individualized approach with standardization of core elements. A higher resolution version of the Graphical abstract is available as Supplementary information.

Mycobacterium fortuitum infection of a hemodialysis catheter in a pediatric patient.

This case report discusses a pediatric patient who developed a hemodialysis catheter line infection from an uncommon etiology, Mycobacterium fortuitum. The initial presentation revealed a well appearing patient with a slow growing skin lesion near the site of the hemodialysis catheter. The treatment course was complicated by resistance to initial antibiotics leading to continued spread of the lesion. The diagnosis was confirmed via skin biopsy of the lesion that required 2 weeks to grow the atypical Mycobacterium. Treatment was successful after hemodialysis catheter removal, transition to peritoneal dialysis, and a prolonged antibiotic course. Mycobacterium fortuitum is a rare cause of dialysis catheter infections that is resistant to standard antibiotic treatment. Treatment success is improved after removal of the dialysis catheter and prolonged antibiotics based on susceptibilities. This case highlights the importance of keeping atypical Mycobacterium in the differential for patients with slow growing skin lesions near dialysis catheter sites with resistance to initial treatment.