Aspectos epidemiológicos das infecções relacionadas ao cateter venoso central de hemodiálise: um estudo de coorte

Abstract

Kidney failure is currently a worldwide public health problem. In Brazil, there is an increasing number of people who have some urinary dysfunction or who are already undergoing some form of renal replacement therapy. The main treatments for renal failure are conservative treatment, peritoneal dialysis, hemodialysis and renaltransplantation. According to data from the Ministry of Health, approximately 83.4 thousand patients are maintained in public dialysis services in Brazil, 90.8% of which are submitted to hemodialysis. For hemodialysis to occur it is necessary to establish a blood access that can be an arteriovenous fistula or a central venous catheter. Althoughthere are advantages, the presence of a catheter is associated with risks to its patients, such as the occurrence of bloodstream infections, its insertion site and the growth of intraluminal biofilm. Despite the great advances in the prevention and treatment of central venous catheter-related infections, this disease is still frequent in the dialysisunits. It is believed that the presence of risk factors in these patients contributes significantly to the maintenance of incidence rates and prevalence. In the United States, the average incidence is around 3/1000 catheter-days. In Brazil, this rate reaches even higher values. Infections related to the hemodialysis catheter contribute to clinical worsening of the patients, with increased morbidity and mortality, length of stay andhospital costs. The objectives of this study were to analyze the epidemiological aspects of catheter-related infections in patients submitted to hemodialysis at the dialysis center of a general and large hospital in Belo Horizonte from 2013 to 2016 and to estimate therisk factors for disease, incidence rate and major microorganisms. This is a nonconcurrent cohort study. The study population consisted of all patients with chronic renal disease, submitted to hemodialysis using a catheter as a route of access to blood circulation. The sample consisted of 525 catheters. The incidence rate of infection in the study was 5.46 / 1000-day catheter. The use of short-stay catheters and implant in thefemoral vein (p-value 0.002 and 0.026, respectively) were considered as risk factors for infections. The results of this research showed that infections related to the central venous catheter of hemodialysis are frequent in Brazil and in the world. Thus, efforts for its prevention and control are necessary, as well as the realization of new studies todeepen the knowledge in the area.