Infecciones de acceso vascular en hemodiálisis atendidos en el Hospital IESS Ceibos
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
Resumen
La falla renal crónica es una de las principales complicaciones de los pacientes con hipertensión y diabetes mellitus tipo II mal controlada. Cuando el nivel de filtrado glomerular cae por debajo de 10 ml/min/kg la terapia sustitutiva renal es un hecho, sea por hemodiálisis o peritoneal, para lo cual se necesita un acceso vascular sea catéter temporal, permanente o fistula para su realización. Sin embargo, la falta de higiene de los pacientes y técnicas no apropiadas de conexión y manipulación de catéter por el personal de salud, favorecen la colonización y predisposición a bacteria vinculada a la infección de acceso vasculares en el servicio de hemodiálisis. En Ecuador no se han reportado estadísticas confiables sobre este tema, por ello nuestro trabajo de titulación vinculado al servicio de nefrología y Hemodiálisis Del Hospital General Ceibos Norte, demostró que la incidencia de infecciones es del 62% (114 pacientes) durante el primer semestre del 2018, con un total de 276 (junio) pacientes que reciben tratamiento dialítico, donde el 41% fue infección por primera vez y 21% reinfección; obteniendo un riesgo relativo de 1.61 con riesgo atribuible a expuestos del 0.62. Con catéteres temporales en el 78% de los casos, 14% permanentes y 8% fistulas, vinculados a bacteriemia resta cada por hemocultivo. Nuestro trabajo pretende ser la base para que el servicio de nefrología y hemodiálisis realice protocolos capaces de reducir esta cifra tan elevada.
Chronic renal failure is one of the main complications in patients with hypertension and poorly controlled type II diabetes mellitus. When the level of glomerular filtration drops below 10 ml / min / kg, renal replacement therapy is a fact, either by hemodialysis or peritoneal, for which a vascular access is needed, whether temporary, permanent catheter or fistula for its realization. However, the lack of patient hygiene and inappropriate techniques for connection and manipulation of the catheter by health personnel favor the colonization and predisposition to bacteria linked to the vascular access infection in the hemodialysis service. In Ecuador, no reliable statistics have been reported on this topic, which is why our titration work linked to the nephrology and hemodialysis service of the General Hospital Ceibos Norte, showed that the incidence of infections is 62% (114 patients) during the first semester of the year. 2018, with a total of 276 (June) patients receiving dialysis treatment, where 41% was infected for the first time and 21% reinfected; obtaining a relative risk of 1.61 with risk attributable to exposed 0.62. With temporary catheters in 78% of cases, 14% permanent and 8% fistulas, linked to bacteremia subtracted each blood culture. Our work aims to be the basis for the nephrology and hemodialysis service to carry out protocols capable of reducing this high number.
Chronic renal failure is one of the main complications in patients with hypertension and poorly controlled type II diabetes mellitus. When the level of glomerular filtration drops below 10 ml / min / kg, renal replacement therapy is a fact, either by hemodialysis or peritoneal, for which a vascular access is needed, whether temporary, permanent catheter or fistula for its realization. However, the lack of patient hygiene and inappropriate techniques for connection and manipulation of the catheter by health personnel favor the colonization and predisposition to bacteria linked to the vascular access infection in the hemodialysis service. In Ecuador, no reliable statistics have been reported on this topic, which is why our titration work linked to the nephrology and hemodialysis service of the General Hospital Ceibos Norte, showed that the incidence of infections is 62% (114 patients) during the first semester of the year. 2018, with a total of 276 (June) patients receiving dialysis treatment, where 41% was infected for the first time and 21% reinfected; obtaining a relative risk of 1.61 with risk attributable to exposed 0.62. With temporary catheters in 78% of cases, 14% permanent and 8% fistulas, linked to bacteremia subtracted each blood culture. Our work aims to be the basis for the nephrology and hemodialysis service to carry out protocols capable of reducing this high number.
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Infecciones relacionadas con catéteres, Dispositivos de acceso vascular, Diálisis renal, Hospital IESS Los Ceibos, Cantón Guayaquil, Ecuador, Insuficiencia renal crónica