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Gomes Cochicho J, Silva JM, Viegas M. Infection of Multiple Tunneled Dialysis Catheters Resulting From the Contamination of the Chlorhexidine Solution by Serratia marcescens. Cureus 2023; 15:e45693. [PMID: 37868447 PMCID: PMC10590121 DOI: 10.7759/cureus.45693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Tunnelled dialysis catheters continue to be a choice in several patients as hemodialysis access. According to Kidney Disease Outcomes Quality Initiative guidelines, its handling implies disinfection, that can be performed using chlorhexidine solutions. Theoretically, these solutions have bactericidal capacity at concentrations greater than 0.12%. We present a curious situation of failure of the antiseptic process due to contamination of the chlorhexidine solution 4% of aqueous base. In this hemodialysis clinic, three cases of infections by the bacteria Serratia marcescens were identified over 2 weeks - in two of the cases, identified in blood culture, and in the other case in the exudate from the exit site of the catheter. Considering the abnormal number of infections by this agent and the fact that these patients were on different shifts, were treated in different rooms, and handled by different nurses, the antiseptic solutions used in the different hemodialysis rooms were analyzed, as well as a closed package from the same batch. After microbiological tests were performed on the antiseptic solution, we identified the growth of Serratia marcescens. This result identified the culprit as being the contamination of the 4% chlorhexidine solution. The competent authorities were notified, and the disinfection method was changed to use a chlorhexidine alcohol-based solution.
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Affiliation(s)
- Joana Gomes Cochicho
- Internal Medicine Department, Hospital Doutor José Maria Grande, Portalegre, PRT
- Hemodialysis Department, Centro de Portalegre, Fundação Renal Portuguesa, Portalegre, PRT
| | - José Miguel Silva
- Internal Medicine Department, Hospital Doutor José Maria Grande, Portalegre, PRT
| | - Marcio Viegas
- Nephrology Department, Hospital Doutor José Maria Grande, Portalegre, PRT
- Hemodialysis Department, Centro de Portalegre, Fundação Renal Portuguesa, Portalegre, PRT
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2
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Park HC, Lee YK, Cho JH, Lee SH, Kim DK, Kim SN, Yang CW. Fighting COVID-19: The role of a COVID-19 Task Force Team. Kidney Res Clin Pract 2021; 40:501-504. [PMID: 34510855 PMCID: PMC8476294 DOI: 10.23876/j.krcp.21.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Nam Kim
- Kim Seong Nam Internal Medicine Clinic, Seoul, Republic of Korea
| | - Chul-Woo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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3
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Alduraywish A, Ragheb M, Taher I, Louis N, Aldossari K, Kishk R. Prevalence, risk factors and impact of occult HCV infection on liver morbidity among haemodialysis patients: hospital-based cross-sectional study. Scand J Gastroenterol 2020; 55:963-969. [PMID: 32649843 DOI: 10.1080/00365521.2020.1790649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Haemodialysis (HD) patients are at risk for blood-borne infections as occult HCV infection, which justifies comprehensive studies. We aimed to determine the prevalence and risk factors of occult HCV infection (OCI) among HD patients. MATERIAL AND METHODS One hundred eligible HD patients, with no evidence of overt HCV or HBV and HBV vaccinated were recruited, and tested for HCV, HBV markers and HCV RNA. Two HCV-positive patients were excluded and peripheral mononuclear cells of 98 patients were verified for viraemia. RESULTS OCI was detected in eight (8.16%); with a median viral load of 7010copies/ml. Their mean age was 30.63 (±18.87 years) compared to others (41.73 ± 15.93) (p = .069). History of surgery, dental procedure, and blood transfusion was comparably high in both groups (p > .05). All OCI patients underwent dialysis twice weekly compared to 48.9% of non-OCI patients (p = .006). OCI patients had a significantly higher mean duration of dialysis (12.63 ± 6.74 years), and a significantly higher frequency (50%) of HCV Ab compared to 6.48 ± 4.76, and 10%, respectively, in non-OCI patients. None of OCI patients was reactive to HBcAb compared to 34 (37.8%) patients without (p = .048). Evidence of liver morbidity was detected in 5 (62.5%) OCI patients compared to 43 (47.7%) of non-OCI patients (p > .05). CONCLUSION Among our HD patients, OCI is considered a comorbid finding associated with mild liver morbidity that warrants strict infection control and periodic testing for blood borne infections.
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Affiliation(s)
| | - Mostafa Ragheb
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ibrahim Taher
- Department of Pathology, Faculty of Medicine, Jouf University, Skaka, Saudi Arabia
| | - Nageh Louis
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Khaled Aldossari
- Department of Family and Community Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Rania Kishk
- Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Park HC, Kim DH, Yoo KD, Kim YG, Lee SH, Yoon HE, Kim DK, Kim SN, Kim MS, Jung YC, Kim YS, Lee YK. Korean clinical practice guidelines for preventing transmission of coronavirus disease 2019 (COVID-19) in hemodialysis facilities. Kidney Res Clin Pract 2020; 39:145-150. [PMID: 32408730 PMCID: PMC7321681 DOI: 10.23876/j.krcp.20.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease that is caused by the novel virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 has become pandemic since December 2019, when the first case developed in Wuhan, China. Patients receiving hemodialysis are more vulnerable to viral transmission because their immune functions are impaired and they receive treatment within a narrow space. Calling on previous experience with Middle East Respiratory Syndrome during the 2015 outbreak, the joint committee of the Korean Society of Nephrology and the Korean Society of Dialysis Therapy quickly formed a COVID-19 task force team to develop a manual before the first index case was diagnosed in the hemodialysis unit. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within hemodialysis facilities, which were developed to protect patients, healthcare workers, and caregivers from this highly transmissible virus. The areas of infection control covered by these guidelines include standard precautions, performing dialysis therapy for confirmed or suspected cases, performing cohort isolation for contact patients, and disease monitoring and contact surveillance. We hope these guidelines help healthcare workers and hemodialysis patients around the world cope with the COVID-19 pandemic.
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Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yang-Gyun Kim
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hye Eun Yoon
- Depatment of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Nam Kim
- Kim Seong Nam Internal Medicine Clinic, Seoul, Republic of Korea
| | - Myeong Sung Kim
- Gojan Myeong Internal Medicine Clinic, Ansan, Republic of Korea
| | - Yoon Chul Jung
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
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Jung HY, Lim JH, Kang SH, Kim SG, Lee YH, Lee J, Chang HH, Kim SW, Choi JY, Cho JH, Kim CD, Kim YL, Park SH. Outcomes of COVID-19 among Patients on In-Center Hemodialysis: An Experience from the Epicenter in South Korea. J Clin Med 2020; 9:jcm9061688. [PMID: 32498262 PMCID: PMC7355817 DOI: 10.3390/jcm9061688] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with advanced chronic kidney disease (CKD) or who are on hemodialysis (HD) could have increased susceptibility to the 2019 coronavirus disease (COVID-19) given their pre-existing comorbidities, older age, compromised immune system, and regular visits to populated outpatient dialysis centers. This study included 14 consecutive patients on HD or with advanced CKD who initiated HD after being diagnosed with laboratory-confirmed COVID-19 from February to April 2020 in hospitals throughout Daegu, South Korea. The included patients, 42.9% of whom were men, had a mean age of 63.5 years. Four patients had a history of contact with a patient suffering from COVID-19. The most common symptom was cough (50.0%), followed by dyspnea (35.7%). The mean time from symptom onset to diagnosis and admission was 2.6 and 3.5 days, respectively. Patients exhibited lymphopenia and elevated inflammatory markers, including C-reactive protein and ferritin. Chest radiography findings showed pulmonary infiltration in 10 patients. All patients underwent regular HD in a negative pressure room and received antiviral agents. Four patients received mechanical ventilation and continuous renal replacement therapy at a median duration of 14.0 and 8.5 days, respectively. One patient underwent extracorporeal membrane oxygenation for three days. Among the 14 patients included, two died due to acute respiratory distress syndrome, nine were discharged from the hospital, and three remained hospitalized. Despite the high-risk conditions associated with worse outcomes, patients on HD did not exhibit extremely poor overall COVID-19 outcomes perhaps due to early diagnosis, prompt hospitalization, and antiviral therapy.
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Affiliation(s)
- Hee-Yeon Jung
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-Y.J.); (J.-H.L.); (J.-Y.C.); (J.-H.C.); (C.-D.K.)
| | - Jeong-Hoon Lim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-Y.J.); (J.-H.L.); (J.-Y.C.); (J.-H.C.); (C.-D.K.)
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu 42415, Korea;
| | - Seong Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu 42472, Korea;
| | - Yong-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-H.L.); (J.L.)
| | - Jaehee Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (Y.-H.L.); (J.L.)
| | - Hyun-Ha Chang
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-H.C.); (S.-W.K.)
| | - Shin-Woo Kim
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-H.C.); (S.-W.K.)
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-Y.J.); (J.-H.L.); (J.-Y.C.); (J.-H.C.); (C.-D.K.)
| | - Jang-Hee Cho
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-Y.J.); (J.-H.L.); (J.-Y.C.); (J.-H.C.); (C.-D.K.)
| | - Chan-Duck Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-Y.J.); (J.-H.L.); (J.-Y.C.); (J.-H.C.); (C.-D.K.)
| | - Yong-Lim Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-Y.J.); (J.-H.L.); (J.-Y.C.); (J.-H.C.); (C.-D.K.)
- Correspondence: (Y.-L.K.); (S.-H.P.); Tel.: +82-53-200-5553 (Y.-L.K.); +82-53-200-5547 (S.-H.P.); Fax: +82-53-423-7583 (Y.-L.K.); +82-53-421-5547 (S.-H.P.)
| | - Sun-Hee Park
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Korea; (H.-Y.J.); (J.-H.L.); (J.-Y.C.); (J.-H.C.); (C.-D.K.)
- Correspondence: (Y.-L.K.); (S.-H.P.); Tel.: +82-53-200-5553 (Y.-L.K.); +82-53-200-5547 (S.-H.P.); Fax: +82-53-423-7583 (Y.-L.K.); +82-53-421-5547 (S.-H.P.)
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Cho JH, Kang SH, Park HC, Kim DK, Lee SH, Do JY, Park JW, Kim SN, Kim MS, Jin K, Kang GW, Park SH, Kim YL, Lee YK. Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea. J Am Soc Nephrol 2020; 31:1398-1408. [PMID: 32482688 DOI: 10.1681/asn.2020040461] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Health care-associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation-separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)-on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. METHODS Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. RESULTS As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. CONCLUSIONS The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.
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Affiliation(s)
- Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seok Hui Kang
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym University College of Medicine, Hallym Kidney Research Institute, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jun Young Do
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Jong Won Park
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Seong Nam Kim
- Department of Internal Medicine, Kim Seong Nam Internal Medicine Clinic, Seoul, Republic of Korea
| | - Myeong Seong Kim
- Department of Internal Medicine, Gojan Myeong Internal Medicine Clinic, Ansan, Republic of Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Gun Woo Kang
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University College of Medicine, Hallym Kidney Research Institute, Seoul, Korea
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Wu YL, Zhang JJ, Li RJ, Cai CY, Zhang YH, Xu TM, Jiang Y, Xu L, Yang LQ, Yang XY. Prevalence of infections and antimicrobial use among hemodialysis outpatients: A prospective multicenter study. Semin Dial 2020; 33:156-162. [PMID: 32160343 DOI: 10.1111/sdi.12869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022]
Abstract
Hemodialysis patients are vulnerable to infectious diseases and frequent receipt of antimicrobial agents. The aim of this study was to describe the prevalence and characteristics of infections and antimicrobials use among hemodialysis outpatients. We utilized the dialysis event surveillance protocol developed by the National Healthcare Safety Network to conduct a prospective multicenter study in Anhui, China. A total of 41 dialysis centers involving 7393 outpatients were included. Fistula was the most common type of vascular access (85.3%), followed by tunneled central line (12.7%), and non-tunneled central line (1.2%). There were 118 dialysis events with an overall pooled events rate of 1.60 per 100 patient-months. Intravenous antimicrobial start, positive blood culture, and pus, redness, or increased swelling at the vascular access site were detected at rates of 0.91, 0.23, and 0.46 per 100 patient-months, respectively. The prevalence of dialysis events was commonly higher in patients with a central line, and lower in patients with a fistula. Hemodialysis outpatients also had the noteworthy risks of nonaccess infections. Older age, female gender, and having a central line were associated with the increased risk of dialysis events. Findings recommend that regular monitoring and improvement strategies are warranted in management of infections among hemodialysis outpatients.
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Affiliation(s)
- Yi-Le Wu
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing-Jing Zhang
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruo-Jie Li
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chao-Yang Cai
- The Second People's Hospital of Hefei, Hefei, Anhui, China
| | - Ye-Hong Zhang
- Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tong-Mei Xu
- People's Hospital of Chuzhou City, Chuzhou, Anhui, China
| | - Yan Jiang
- Wanbei Coal-Electricity Group General Hospital, Suzhou, Anhui, China
| | - Li Xu
- Lujiang County People's Hospital, Hefei, Anhui, China
| | - Li-Qi Yang
- The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xi-Yao Yang
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Park HC, Lee SH, Kim J, Kim DH, Cho AJ, Jeon HJ, Oh J, Noh JW, Jeong DW, Kim YG, Lee CH, Yoo KD, Lee YK. Effect of isolation practice on the transmission of middle east respiratory syndrome coronavirus among hemodialysis patients: A 2-year prospective cohort study. Medicine (Baltimore) 2020; 99:e18782. [PMID: 32011472 PMCID: PMC7220504 DOI: 10.1097/md.0000000000018782] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.
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Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Juhee Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
| | - Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - AJin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - Hee Jung Jeon
- Hallym University Kidney Research Institute
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul
| | - Jieun Oh
- Hallym University Kidney Research Institute
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul
| | - Jung-Woo Noh
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - Da-Wun Jeong
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Yang-Gyun Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Chang-Hee Lee
- Department of Anesthesiology, Gangneung Medical Center, Gangneung
| | - Kyung Don Yoo
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
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9
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Kim SM, Song IH. Hepatitis C virus infection in chronic kidney disease: paradigm shift in management. Korean J Intern Med 2018; 33:670-678. [PMID: 29961309 PMCID: PMC6030406 DOI: 10.3904/kjim.2018.202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/17/2018] [Indexed: 12/14/2022] Open
Abstract
Hepatitis C virus (HCV) infection in chronic kidney disease (CKD) is associated with increased liver-related morbidity and mortality rates, accelerated progression to end-stage renal disease, and risk of cardiovascular events. CKD patients with HCV infection require antiviral therapy. Pegylated interferon (peg-IFN) plus ribavirin was the standard of care for HCV-infected CKD patients before the introduction of first-generation direct-acting antiviral (DAA) oral anti-HCV agents. Peg-IFN-based treatment has a low virologic response rate and poor compliance, resulting in a high dropout rate. Recently, several clinical trials of all-DAA combination regimens have reported excellent antiviral efficacy and few adverse drug reactions in HCV-infected patients with CKD. These positive results have revolutionized the treatment of chronic HCV infection in this population. In this review, we address the impact of chronic HCV infection in CKD patients, and discuss their management using next-generation DAAs.
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Affiliation(s)
- So Mi Kim
- Division of Nephrology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
| | - Il Han Song
- Division of Hepatology, Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
- Correspondence to Il Han Song, M.D. Division of Hepatology, Department of Internal Medicine, Dankook University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: +82-41-5503924 Fax: +82-41-5563256 E-mail:
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10
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Karkar A. Infection control guidelines in hemodialysis facilities. Kidney Res Clin Pract 2018; 37:1-3. [PMID: 29629271 PMCID: PMC5875570 DOI: 10.23876/j.krcp.2018.37.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ayman Karkar
- Department of Nephrology, Kanoo Kidney Center, Dammam, Saudi Arabia
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