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Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.
Assuntos
Humanos , Masculino , Feminino , COVID-19 , Pacientes , Colômbia , Diagnóstico , Injúria Renal AgudaRESUMO
Introducción: la utilidad del Gram y cultivo de esputo para el manejo y seguimiento de los pacientes con neumonía adquirida en la comunidad (NAC) es aun controversial. Objetivo: describir la frecuencia de cambio del manejo antibiótico de acuerdo con el resultado del cultivo de esputo en enfermos hospitalizados con NAC. Tipo de estudio: descriptivo de corte transversal. Métodos: pacientes ingresados al servicio de medicina interna del Hospitalde San José con diagnóstico clínico y radiológico de NAC que no requirieran manejo en UCI. Se incluyeron 86 casos en un período de cuatro meses a quienes se les aplicó al ingreso la escala de pronóstico CURB 65, la presencia o no de comorbilidades, la positividad del Gram y cultivo de esputo, la estancia hospitalaria y el cambio de antibiótico de acuerdo con el resultado del cultivo de esputo si la muestra era significativa. Resultados: el promedio de edad de la población fue 58.8 años (DS 21.7). El 45% tenía comorbilidades al ingreso y el 37% algún tipo de complicación asociada con la NAC. En la escala de CURB-65 el 52% tenía un punto, dos puntos el 27%, tres el 3.5 % y con cuatro el 2%. La respuesta a la terapia antibiótica se observó en el 85% y la frecuencia del cambio antibiótico según el reporte de cultivo ocurrió en el 10% (6/62). La mediana de días de estancia hospitalaria fue de cinco. El 95% egresó del hospital y el 5% restante fue trasladado a otro servicio. Conclusiones: el Gram y cultivo de esputo son ayudas diagnósticas de bajo costo y útiles en pacientes con NAC clasificados segúnlas escalas de severidad de alto riesgo o neumonías severas, en donde el aislamiento del germen es crucial paradirigir la terapia antibiótica; en neumonías no severas no han demostrado mayor utilidad ya que pocas veces hay aislamiento del germen y no generan cambios en el manejo del paciente. Se debe asegurar la adecuada toma y procesamiento para aumentar la probabilidad de aislamiento.
Introduction: the applicability of sputum Gram stain and culture to define management and follow-up of patients with community-acquired pneumonia (CAP) remains controversial. Objective: to describe the frequency of changes in antimicrobial therapy based on results of sputum culture in hospitalized patients with CAP. Type of study: this is a descriptive cross sectional study. Methods: patients admitted to the Internal Medicine Department at the San José Hospital with radiologic and clinic diagnosis of CAP who did not require ICU care were selected. Eighty-six (86) cases in a four-month period were included. They were graded with the CURB-65 prediction scale upon admission considering comorbid factors, positive sputum Gram stain and culture, hospital stay and change of antimicrobial therapy based on the result of the sputum culture when sample was substantial. Results: the mean age of the study population was 58,8 years (SD 21,7). Forty-five percent (45%) had comorbidities upon admission and 37% had some type of complication associated to CAP. In the CURB-65 scale 52% rated one point, 27% rated two points, 3,5 % three points and 2% four points. Response toantimicrobial therapy was observed in 85% and a change of antimicrobial regime based on culture results occured in 10% (6/62). The median number of days in hospital was five. Ninety-five percent (95%) were discharged from the hospital and the remaining 5% were transferred to another department. Conclusions: sputum Gram stain and culture are low-cost diagnostic tools and are useful in patients with CAP classified acording to the high-risk severity scales or severe pneumonias, in which isolation of the pathogen is crucial to tailor antimocrobial therapy; in non-severe pneumonias they have not shown mayor applicability for in a very small number of cases the etiologic organism is isolated and no changes in patient management are generated...