Eventos infecciosos en pacientes en hemodiálisis

Abstract

Patients undergoing periodic haemodialysis have a depressed immunity with a higher susceptibility to infection. This vulnerability is increased by the need to access their bloodstream and extracorporeal circulation intervals, which can facilitate infection by microorganisms. Infections, only preceded by cardiovascular events, represent in haemodialysis patients the second cause of death, with an attributable mortality of 14%, being infections of vascular accesses the first cause of bacteraemia1-3. Epidemiological surveillance of infectious events and antibiotic resistance of these patients is essential to implement improvement plans that include prevention and control activities. Since 1999, the Centers for Disease and Control in the United States has been implementing an epidemiological surveillance system in haemodialysis known as the Dialysis Surveillance Network. More recently, the National Healthcare Safety Network has been created with similar objectives. In Europe there are multi-centre systems that have published guidelines, indicators and recommendations aimed at minimising the impact of infections on the renal patient. The type of vascular access directly influences the risk of presenting infectious episodes and represents the most important risk factor in the development of bacteremias and infections; it is less risky in arteriovenous fistulas, followed by endovascular prostheses, tunneled catheters and non-tunneled catheters2. Although certain risk factors, such as transfusions or transplants, may be responsible for virus infection in patients with chronic kidney disease, various evidences indicate that transmission between patients may occur by physical contact with the external surfaces of the dialysis equipment, directly or through the hands of the staff handling it2. Among all germs, viruses transmitted by human blood, in particular hepatitis B and hepatitis C viruses, stand out1. With regard to treatment to combat germs, it is clear that doses need to be adjusted and resistance to them avoided. In acute infections such as respiratory ones, empirical treatment with vancomycin without prior culture is usually chosen for its effectiveness and tolerance, although the use of other drugs is a matter of constant research.