Complicaciones infecciosas en pacientes hospitalizados con enfermedad renal crónica en terapia de reemplazo renal: Un estudio observacional en un centro de salud de cuarto nivel en la Costa Caribe colombiana (2019-2024)
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Fecha
2025
Autores
Aroca-Martinez, Gustavo
Pérez Jiménez, Valentina
Perea Rojas, Diana Marcela
Cadena Bonfanti, Andres Angélo
Sarmiento Gutierrez , Joanny Judith
Raad Sarabia, Maria Isabel
daza arnedo, rodrigo andres
Rico-Fontalvo, Jorge
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Sociedad Ecuatoriana de Nefrología, Diálisis y Trasplantes
Resumen
Introducción: La segunda causa de mortalidad en pacientes con insuficiencia renal
son las infecciones, entre las cuales la presencia de dispositivos como catéteres constituye
un factor de riesgo. Este estudio analiza la mortalidad y los factores que contribuyen
a las infecciones relacionadas con catéteres en pacientes con ERC.
Métodos: El presente estudio observacional, se realizó en la Clínica de la Costa (Barranquilla,
Colombia) de 2019 a 2024. Se incluyeron casos de pacientes en hemodiálisis
o diálisis peritoneal, hospitalizados por infecciones de catéteres, con cultivo positivo.
La muestra, se dividió en dos grupos según el desenlace hospitalario: vivos y fallecidos.
Se recolectaron variables sociodemográficas, clínicas, microbiológicas y de
manejo. Se comparan porcentajes con el test de Chi cuadrado y el Odds ratio.
Resultados: Se analizan 78 casos, de los cuales 38 en hemodiálisis y 40 en diálisis
peritoneal; la mortalidad fue del 25.6% (n=20). No se encontraron diferencias en edad,
sexo, comorbilidades crónicas entre los grupos. Los antecedentes de infección previa
y de enfermedad neurológica se identificaron como factores de riesgo (OR: 3.714;
IC95%: 1.04-13.31; P=0.036). Las muertes se asociaron al choque séptico y al ingreso
en la UCI, presentes en el 100% de los fallecidos (P < 0.001). El S. aureus meticilino
resistente fue el principal predictor de mortalidad, presente en el 50% de las defunciones
(OR: 117; P=0.0014). No hubo asociación entre el tipo de dispositivo de acceso o
la modalidad de diálisis y el fallecimiento de los pacientes.
Conclusión: la supervivencia en terapia de reemplazo renal depende de una vigilancia microbiológica estricta y de la personalización
de los cuidados preventivos en pacientes con compromiso cognitivo, lo que permite una intervención temprana antes de
que se establezca una disfunción orgánica irreversible.
Introduction: The second cause of mortality in patients with chronic kidney disease is infections, among which the presence of devices such as catheters is a risk factor. This study examines the factors contributing to catheter-related infections among patients with CKD on the Colombian Caribbean Coast. Methods: The present observational study was conducted at the Clínica de la Costa (Barranquilla, Colombia) from 2019 to 2024. Records of patients on hemodialysis or peritoneal dialysis hospitalized for infections associated with the renal replacement device, with microbiological confirmation by positive culture, were included. The sample was divided into two groups based on hospital outcome: living and deceased. Sociodemographic, clinical, microbiological, and management variables were collected. Percentages are compared with the Chi-square test and the Odds ratio. Results: A total of 78 cases were analyzed, of which 38 were from the hemodialysis program and 40 from the peritoneal dialysis program; in-hospital mortality was 25.6% (n=20). No statistically significant differences were found in age, sex, or chronic comorbidities, such as hypertension or diabetes, between the groups of survivors and deaths. A history of previous infection and neurological disease was identified as a critical risk factor, increasing the probability of death almost fourfold (OR: 3,714; 95%CI: 1,037-13,309; P=0.036). The fatal outcome was closely linked to septic shock and admission to the ICU, which were present in 100% of the deceased (P < 0.001). Microbiologically, methicillin-resistant S. aureus was the main predictor of mortality, present in 50% of deaths with a significantly higher risk than other pathogens (OR: 117; P=0.0014). No significant association was observed between the type of access device or dialysis modality and patient death. Conclusion: Survival on renal replacement therapy depends on strict microbiological surveillance and personalization of preventive care in cognitively compromised patients, allowing early intervention before irreversible organ dysfunction sets in.
Introduction: The second cause of mortality in patients with chronic kidney disease is infections, among which the presence of devices such as catheters is a risk factor. This study examines the factors contributing to catheter-related infections among patients with CKD on the Colombian Caribbean Coast. Methods: The present observational study was conducted at the Clínica de la Costa (Barranquilla, Colombia) from 2019 to 2024. Records of patients on hemodialysis or peritoneal dialysis hospitalized for infections associated with the renal replacement device, with microbiological confirmation by positive culture, were included. The sample was divided into two groups based on hospital outcome: living and deceased. Sociodemographic, clinical, microbiological, and management variables were collected. Percentages are compared with the Chi-square test and the Odds ratio. Results: A total of 78 cases were analyzed, of which 38 were from the hemodialysis program and 40 from the peritoneal dialysis program; in-hospital mortality was 25.6% (n=20). No statistically significant differences were found in age, sex, or chronic comorbidities, such as hypertension or diabetes, between the groups of survivors and deaths. A history of previous infection and neurological disease was identified as a critical risk factor, increasing the probability of death almost fourfold (OR: 3,714; 95%CI: 1,037-13,309; P=0.036). The fatal outcome was closely linked to septic shock and admission to the ICU, which were present in 100% of the deceased (P < 0.001). Microbiologically, methicillin-resistant S. aureus was the main predictor of mortality, present in 50% of deaths with a significantly higher risk than other pathogens (OR: 117; P=0.0014). No significant association was observed between the type of access device or dialysis modality and patient death. Conclusion: Survival on renal replacement therapy depends on strict microbiological surveillance and personalization of preventive care in cognitively compromised patients, allowing early intervention before irreversible organ dysfunction sets in.
Descripción
Palabras clave
Enfermedad renal crónica, Terapia de reemplazo renal, Hemodiálisis, Diálisis peritoneal, Infecciones asociadas
Citación
Aroca Martínez G, Pérez Jiménez V, Perea Rojas D, Cadena Bonfanti A, Sarmiento J, Raad Sarabia M, et al. Complicaciones infecciosas en pacientes hospitalizados con enfermedad renal crónica en terapia de reemplazo renal: Un estudio observacional en un centro de salud de cuarto nivel en la Costa Caribe colombiana (2019-2024). REV SEN 2025;14(1):50-58
