RESUMEN
Renal patients are particularly vulnerable to infection in part because they are relatively, or significantly, immunocompromised, undergo numerous invasive procedures and typically have frequent contact with healthcare institutions putting them at much higher risk of nosocomial infections. In addition, they are typically exposed to multiple antibiotics, which may select out resistant organisms or damage protective microbiomes. The Covid-19 pandemic has brought the life and death importance of infection control to every renal unit and forced a, perhaps overdue, appreciation of the issues and responsibilities associated with nosocomial infections. In addition, our patients are disproportionately impacted by the growing emergence of antimicrobial resistance. This chapter reviews the key aspects of nosocomial infections in renal patients and the important elements of infection control and antibiotic stewardship that can protect our patients. © Springer Nature Switzerland AG 2014, 2022.
RESUMEN
Background: During the COVID-19 pandemic in 2020, high rates of acute kidney injury (AKI) in critically unwell patients are being reported, leading to increased demand for renal replacement therapy (RRT). There are considerable challenges providing RRT for large numbers of patients with COVID-19 and alternatives to continuous veno-venous hemodiafiltration therapies (CVVHDF) in intensive care units (ICU) are needed in both high and low-resource settings. Peritoneal dialysis (PD) can be initiated immediately after percutaneous insertion of the catheter, but there are concerns about impact on ventilation and RRT efficacy. We describe our recent experience of percutaneous catheter insertion and peritoneal dialysis in patients in ICU with COVID-19 infection. Methods: Patients were selected according to local protocol and catheters inserted percutaneously using Seldinger technique by two experienced operators. Sequential Organ Failure Assessment score (SOFA) and ventilation requirements were recorded at time of insertion, and at 24 hours after insertion. Procedure complications, proportion of RRT provided by PD, renal recovery and RRT parameters during PD were assessed. Results: Percutaneous PD catheters were successfully inserted in 32/39 (82.1%) patients after median of 10.0 (IQR 13.0, 19.0) days on ICU. No adverse events following insertion were reported, SOFA scores and ventilation requirements were comparable before and after insertion and adequate RRT parameters were achieved. Median proportion of RRT provided by PD following catheter insertion was 90.2% (IQR 77.5, 100). Conclusions: PD provides a safe and effective alternative to CVVHDF in selected patients with AKI and COVID-19 infection requiring ventilation on intensive care.