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Canadian journal of kidney health and disease, v.3, 2016년, pp.24 -
Lata, Chris (Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Canada) , Girard, Louis (Division of Nephrology, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9 Canada) , Parkins, Michael (Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Canada) , James, Matthew T. (Division of Nephrology, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9 Canada)
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Purpose of the reviewPatients with end-stage renal disease (ESRD) are at a high risk of bacterial infection. We reviewed publications on risk factors, prevention, and treatment paradigms, as well as outcomes associated with bacterial infection in end-stage kidney disease. We focused in particular on...
ABRÉGÉBut de la revueLes patients souffrant d’insuffisance rénale terminale (IRT) sont à risque élevé de contracter une infection bactérienne. Nous avons effectué une revue des publications faisant état des facteurs de risque, des paradigmes de prévention et de traitement, ainsi que des pronostics associés à la contraction d’une septicémie en situation d’IRT. On a porté une attention particulière aux études conduites au Canada, où le taux d’hémodialyse par accès vasculaire est élevé.SourcesNous avons inclus tous les articles rédigés en anglais répertoriés sur MEDLINE qui répondaient aux critères de recherche suivants : « hémodialyse », « insuffisance rénale chronique » et « infection bactérienne ». L’accent a été mis sur les articles portant sur des études s’étant tenues au Canada, en incluant des comparaisons aux pronostics et aux standards internationaux lorsque possible.ConstatationsLa plupart des infections bactériennes dans ce contexte particulier sont attribuables à des bactéries Gram positif, plus spécifiquement à Staphylococcus aureus résistant à la méthicilline (SARM), l’agent infectieux présentant le moins bon pronostic. Un modèle de soins collaboratifs, basé sur un plan standardisé et conforme à des indicateurs de la santé éprouvés, où interviennent l’équipe de néphrologie et un spécialiste des maladies infectieuses, figure parmi les interventions pouvant réduire le risque de mortalité par septicémie. On a également observé qu’on pouvait réduire le taux de mortalité associé à ce type d’infections en prescrivant l’antibiotique adéquat à la dose optimale, de même qu’en évitant la réutilisation du cathéter. De plus, on a constaté que l’emploi d’une solution de blocage contenant du t-PA (activateur tissulaire du plasminogène) dans le dispositif de verrouillage du cathéter ainsi que l’application topique de mupirocine ou de polysporin au point d’émergence du cathéter permettaient de réduire l’incidence des infections.Limites de l’étudeIl existe très peu d’essais cliniques randomisés rapportant des stratégies de prévention ou de traitement des bactériémies liées à l’utilisation de cathéters pour l’hémodialyse.ConséquencesÉtant donné la prévalence élevée d’utilisation de cathéters dans les unités de dialyse au Canada, il est suggéré d’effectuer des études supplémentaires afin d’élaborer des stratégies à long terme pour la prévention et le traitement des infections du sang.
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