Factores de riesgo asociados a infección de catéter de hemodiálisis en un centro de referencia
Palabras clave:
infecciones, catéteres, hemodiálisis, infecciones asintomáticas, infecciones relacionadas con catéteres
Resumen
Introducción: la infección asociada a catéter de hemodiálisis es una causa importante de morbimortalidad en los pacientes que requieren hemodiálisis de manera permanente, elevando el riesgo de mortalidad 2 veces más de los que no lo tienen. Por esto resulta imprescindible determinar los factores predisponentes a adquirir esta infección.
Objetivos: determinar los factores de riesgo asociados a la infección del catéter de hemodiálisis de los pacientes en el Hospital Nacional de Itauguá.
Métodos: se realizó un estudio observacional de casos y controles de 104 pacientes, 52 pacientes como casos y 52 como controles.
Resultados: se analizaron las siguientes variables cualitativas como factores de riesgo: desconocimiento del cuidado del catéter (OR: 9,66; p: <0,05), ausencia de turno fijo trisemanal (OR: 3,70; p: <0,05), diabetes mellitus (OR: 1; p: >0,05), hipertensión arterial (OR: 1,17; p: >0,05) ausencia de infección previa (OR: 2,25; p: <0,05), procedencia rural (OR: 2,67; p: <0,05), ubicación del catéter femoral (OR: 6,51; p: <0,05), colonización con Staphylococcus aureus (OR: 15,6; p: <0,05), curación única semanal (OR: 37,40; p: <0,05) y escolaridad primaria (OR: 2,93; p: <0,05). En cuanto a las variables cuantitativas se analizaron la edad (p: <0,05), tiempo de instalación del catéter (p: <0,05) y tiempo de evolución de la hemodiálisis (p: 0,2)
Conclusión: se asociaron de manera significativa a la infección de catéter de hemodiálisis el desconocimiento del cuidado del catéter, la ausencia de turno fijo trisemanal, la procedencia rural, la colonización con Staphylococcus aureus, la curación una vez por semana del catéter y la escolaridad primaria, la edad mayor a 51 años y la instalación reciente del catéter.
Citas
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3. Fariñas MC, García-Palomo JD, Gutiérrez-Cuadra M. Infecciones asociadas a los catéteres utilizados para la hemodiálisis y la diálisis peritoneal. Enferm Infecc Microbiol Clin. 2008;26(8):518–26
4. Gómez J, Pimienta L, Pino R, Hurtado M, Villaveces M. Prevalencia de infección asociada a catéter de hemodiálisis en el Hospital Universitario Clínica San Rafael. Rev Colomb Nefrol. 2018;5(1):17-25. doi: https://doi.org/10.22265/acnef.5.2.283
5. Grothe C, Goncalves da Silva Belasco A, de Cassia Bittencour AR, Amaral Carneiro Vianna L, Sesso RCC, Barbosa DA. Incidencia de infección de la corriente sanguínea en los pacientes sometidos a hemodiálisis por catéter venoso central. Rev Latino-Am Enfermagem. 2010;18(1):1–8. doi: https://doi.org/10.1590/S0104-11692010000100012
6. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45. doi: 10.1086/599376
7. Selby LM, Rupp ME, Cawcutt KA. Prevention of Central-Line Associated Bloodstream Infections: 2021 Update. Infect Dis Clin North Am. 2021 Dec;35(4):841-856. doi: 10.1016/j.idc.2021.07.004
8. Souza Fram D, Taminato M, Ferreira D, Neves L, Gonçalves Silva Belasco A, Barbosa DA. Prevenção de infecções de corrente sanguínea relacionadas a cateter em pacientes em hemodiálise. Acta Paul Enferm. 2009;22(spe1):564–8. doi: https://doi.org/10.1590/S0103-21002009000800024
9. Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. J Infect Public Health [Internet]. 2017 [cited 2021 Feb 10];10(4):403–8. Available from: https://www.sciencedirect.com/science/article/pii/S1876034116300971?via%3Dihub. doi: https://doi.org/10.1016/j.jiph.2016.06.008
10. Lok ChE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int [Internet]. 2011 [cited 2021 Feb 10];79(6):587–98. Available from: https://www.kidney-international.org/article/S0085-2538(15)54851-5/fulltext. doi: 10.1038/ki.2010.471
11. Gebreselassie HM, Lo Priore E, Marschall J. Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis. J Hosp Infect. 2015; 91(3):250–6. doi: 10.1016/j.jhin.2015.08.015
12. Lederer SR, Riedelsdorf G, Schiffl H. Nasal carriage of meticillin resistant Staphylococcus aureus: the prevalence, patients at risk and the effect of elimination on outcomes among outclinic haemodialysis patients. Eur J Med Res. 2007;12(7):284–8
13. Elzorkany KMA, Elbrolosy AM, Salem EH. Methicillin-Resistant Staphylococcus aureus carriage in hemodialysis vicinity: Prevalence and decolonization approach. Indian J Nephrol [Internet]. 2019 [cited 2021 Nov 17];29(4):282–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668309/. doi: 10.4103/ijn.IJN_56_18
14. Morales-Antón CY. Factores asociados a infección por catéter en los pacientes diabéticos hemodializados del hospital nacional Daniel Alcides Carrión durante el periodo 2015-2017 [Tesis]. Lima: Universidad Ricardo Palma, Facultad de Medicina Humana Manuel Huamán Guerrero; 2018. [Internet] [citado 17 Oct 2021]. Disponible en: http://repositorio.urp.edu.pe/bitstream/handle/URP/1179/111%20-%20TESIS%20MORALES%20ANTON%20hecho.pdf?sequence=1&isAllowed=y
15. Kumbar L, Yee J. Current concepts in hemodialysis vascular access infections. Adv Chronic Kidney Dis. 2019;26(1):16–22. doi: 10.1053/j.ackd.2018.10.005
16. Ali M, Das B, Kumar S, Memon R, Dayu B, Babeeta. Catheter related infection in hemodialysis patients with double lumen catheter. Professional Med J. 2019;26(8):1278–82. doi: https://doi.org/10.29309/TPMJ/2019.26.08.3869
17. Vanholder R, Canaud B, Fluck R, Jadoul M, Labriola L, Marti-Monros A, et al. Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP). NDT Plus [Internet]. 2010 [cited 2021 Nov 9];3(3):234–46. Available from: https://academic.oup.com/ckj/article/3/3/234/2918990. doi: https://doi.org/10.1093/ndtplus/sfq041
18. Zhang HH, Cortés-Penfield NW, Mandayam S, Niu J, Atmar RL, Wu E, et al. Dialysis catheter–related bloodstream infections in patients receiving hemodialysis on an emergency-only basis: A retrospective cohort analysis. Clin Infect Dis [Internet]. 2019 [cited 2021 Nov 9];68(6):1011–6. Available from: https://academic.oup.com/cid/article/68/6/1011/5050706. doi: https://doi.org/10.1093/cid/ciy555
19. Crespo Garrido M, Ruiz Parrado MC, Gómez Pozo M, Crespo Montero R. Las bacteriemias relacionadas con el catéter tunelizado de hemodiálisis y cuidados de enfermería. Enferm Nefrol. 2017;20(4):353–65. doi: https://doi.org/10.4321/S2254-28842017000400009
20. D’Amato-Palumbo S, Kaplan AA, Feinn RS, Lalla RV. Retrospective study of microorganisms associated with vascular access infections in hemodialysis patients. Oral Surg Oral Med Oral Pathol Oral Radiol [Internet]. 2013 [cited 2021 Nov 9];115(1):56–61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880246/. doi: 10.1016/j.oooo.2012.08.445
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