Prophylactic treatment of chronic renal disease in patients undergoing peritoneal dialysis and colonized by Staphylococcus aureus: a systematic review and meta-analysis.

BACKGROUND: This study was performed to evaluate the clinical effectiveness of alternative strategies for the prevention and treatment of patients with chronic kidney disease undergoing peritoneal dialysis and colonized by Staphylococcus aureus. METHODS: A systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were "Staphylococcus aureus," "MRSA," "MSSA," "treatment," "decolonization," "nasal carrier," "colonization," "chronic kidney disease," "dialysis," and "peritoneal dialysis." Randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various antibiotic treatments (antibiotic group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). Patients in the antibiotic group were also compared with those in the mupirocin group. RESULTS: In total, nine studies involving 839 patients were included in the analysis, 187 (22.3 %) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for peritoneal dialysis was 74 % lower in the mupirocin than control group (odds ratio [OR], 0.26; 95 % confidence interval [CI], 0.14-0.46; p < 0.001), 56 % lower in the antibiotic than control group (OR, 0.44; 95 % CI, 0.19-0.99; p = 0.048), and 52 % lower in the mupirocin than antibiotic group (OR, 0.48; 95 % CI, 0.21-1.10; p = 0.084). The difference in the probability of S. aureus peritonitis in patients undergoing peritoneal dialysis was not statistically significant among the three groups. CONCLUSIONS: Mupirocin and topical antibiotics were effective for reduction of S. aureus catheter site infection in patients undergoing peritoneal dialysis when compared with no treatment or placebo. However, evidence was insufficient to identify the optimal agent, route, or duration of antibiotics to treat peritonitis.

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study.

BACKGROUND: Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis. METHODS: Risk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case-control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis. RESULTS: There were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17-24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9-23.09). CONCLUSIONS: Infection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

[Prevalence of infection in kidney transplantation from living versus deceased donor: systematic review and meta-analysis]. / Prevalência de infecção em transplante renal de doador vivoversus falecido: revisão sistemática e metanálise.

OBJECTIVE: To verify if the type of donor is a risk factor for infection in kidney transplant recipients. METHODS: Systematic Review of Literature with Meta-analysis with searches conducted in the databases MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS: We selected 198 studies and included four observational studies describing infections among patients distinguishing the type of donor. Through meta-analysis, it was shown that in patients undergoing deceased donor transplant, the outcome infection was 2.65 higher, than those who received an organ from a living donor. CONCLUSION: The study showed that deceased kidney donor recipients are at an increased risk for developing infections and so the need for establishing and enforcing protocols from proper management of ischemic time to the prevention and control of infection in this population emerges.

Screening and treatment for Staphylococcus aureus in patients undergoing hemodialysis: a systematic review and meta-analysis.

BACKGROUND: This study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus. METHODS: A systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were "Staphylococcus aureus", "MRSA", "MSSA", "treatment", "decolonization", "nasal carrier", "colonization", "chronic kidney disease", "dialysis", and "haemodialysis" or "hemodialysis". Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia. RESULTS: In total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05-0.34; p<0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08-0.42; p<0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51-1.15; p=0.20). CONCLUSIONS: Twenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.

Quality of life associated with nursing professionals' individual resources and work.

OBJECTIVES: to assess the physical and mental components of nursing professionals' quality of life and associate them with individual, health and work characteristics. METHODS: cross-sectional research, with nursing professionals from a university hospital in São Paulo. Own questionnaire and validated instruments were applied. RESULTS: the overall quality of life was compromised. The physical component was lower in relation to low family income and among those who perceived greater control/pressure at work, and better for those who practiced physical activity and had support of leader and organization. The mental component was lower in professionals who reported dissatisfaction with work, worse self-rated physical health and were older. Scores for both components reduced due to work-related illnesses, worse work ability and increased daytime sleepiness. CONCLUSIONS: quality of life was statistically associated with controllable institutional factors and individual resources that, except age, can be promoted.

Sepsis and COVID-19: outcomes in young adults in intensive care.

OBJECTIVE: to verify sepsis incidence among young adults admitted to intensive care due to COVID-19 and to analyze its association with demographic, clinical and outcome variables. METHODS: a quantitative, longitudinal, retrospective and analytical study, consisting of 58 adults aged 20 to 40 years in intensive care for SARS-CoV-2. It was carried out in a university hospital, from March 2020 to December 2021, with data collected from electronic medical records. RESULTS: sepsis incidence was 65%. Sepsis was associated with acute kidney injury, use of vasoactive drugs and mechanical ventilation, being admitted to the emergency room, severity according to the Simplified Acute Physiology Score III and bacterial pulmonary co-infection, the latter being the most frequent etiology for sepsis. CONCLUSIONS: there was a high sepsis incidence, with 42% of deaths, which points to the importance of investing in preventive measures, especially in relation to bacterial pulmonary coinfections.

Sociodemographic factors associated with suicidal behavior at a federal public university in the Western Brazilian Amazon.

OBJECTIVE: to determine risk factors for suicidal behavior among students and employees of a federal public university in the Brazilian Western Amazon. METHODS: an analytical cross-sectional study of survey and association between variables with a sample of 475 participants. Statistical analyzes were performed using the Mann-Whitney test, Pearson's chi-square test, likelihood ratio test or Fisher's exact test and a logistic regression model. A significance level of 5% was used (p-value< 0.05). RESULTS: a higher proportion of suicidal behavior was found in younger participants, females, who had no religion or had one, but were non-practicing, who did not have children and/or had a monthly family income of less than two minimum wages. Lower proportions of suicidal behavior were identified in heterosexuals and/or married or in a stable relationship. CONCLUSION: the study suggests a relationship between sociodemographic factors and suicidal behavior in the studied academic community.

Contrast-induced acute kidney injury in patients submitted to coronary angioplasty: prospective cohort.

OBJECTIVE: To analyze the incidence, risk factors, and associations of clinical outcomes for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after coronary angioplasty. METHOD: Prospective cohort of 182 patients followed for three months after undergoing angioplasty, from July 2020 to June 2021. The analyzed variables were sociodemographic, clinical, and those related to the procedure. RESULTS: The incidence of CI-AKI was 35.7% (n = 65) and was associated with old age, diabetes mellitus, and chronic kidney disease (p = 0.004, p < 0.001, and p = 0.009, respectively). Out of the 17 patients who died within 90 days, 76.5% had CI-AKI (n = 13), the odds ratio between death and CI-AKI was approximately 7.2 times (95% confidence interval (CI), [2.41;26.36]; p = 0.001). The decrease of one unit in the patient's baseline hemoglobin showed a 6.5% increase for CI-AKI (95% CI, [-0.089; -0.040]; p < 0.0001). CONCLUSION: CI-AKI is prevalent in patients with ACS after angioplasty and is related to diabetes mellitus and chronic kidney disease, showing high mortality rates.

Religious/spiritual experiences, quality of life and satisfaction with life of hospitalized octogenarians.

OBJECTIVES: to assess quality of life (QoL) and satisfaction with life (SWL) indices and verify whether the frequency of religious and spiritual experiences is associated with QoL and SWL in hospitalized octogenarians. METHOD: this is a cross-sectional study, with 128 octogenarians. World Health Organization QoL instruments and Scales applied: Daily Spiritual Experience (DSES) and Satisfaction With Life (SWLS). RESULTS: more committed domains related to QoL and SWL: autonomy and physical capacity. The higher the score in DSES, the higher the scores in the psychological domains and past, present, and future QoL activities. The higher the score in DSES, the higher the score in the social involvement aspect. CONCLUSION: the results of this study showed that the higher frequency of religious and spiritual experiences of hospitalized elderly people was associated with better QoL and SWL. It is emphasized that religious and spiritual experiences should be explored in the hospital therapeutic context.

Anxiety level of public university employees with suspected or confirmed COVID-19 infection.

Introduction: Workers on leave awaiting confirmation of coronavirus infection may experience worry and anticipatory stress. Objectives: The objective of this study was to assess the anxiety levels of employees at a public university in the state of São Paulo who were put on leave due to suspected or confirmed SARS-CoV-2 infection and to correlate their anxiety levels with personal and work-related variables. Methods: This cross-sectional study used an online survey to collect data from employees who took a diagnostic test for COVID-19. The participants' anxiety level was measured using Greenberger and Padesky's Anxiety Inventory, while data on personal and work-related variables were collected through a socio-demographic questionnaire. Results: Most of the 153 participants (76.5%) reported anxiety symptoms. COVID-19 infection was confirmed in 51%. The highest prevalence of severe anxiety (27%) was among employees who had indirect contact with COVID-19 patients. Three variables - being a woman, being a regular employee, and previous physical health problems - were responsible for a higher risk of anxiety. Conclusions: This study's findings indicate the need to protect the mental health of the university's employees.

Urinary tract infection in patients with chronic kidney disease under conservative treatment.

OBJECTIVES: to assess the prevalence and associated risk factors for urinary tract infection in patients with chronic kidney disease under conservative treatment and identify the microorganisms isolated in the urine of these patients and the staging of chronic kidney disease. METHODS: a cross-sectional, analytical study carried out at the Conservative Treatment Outpatient Clinic of a university hospital in the city of São Paulo. RESULTS: the prevalence of urinary tract infection is 22%. The risk factors Diabetes Mellitus, hypertension, heart disease, neoplasms and thyroid and autoimmune diseases stand out in the infected group (p < 0.001). Most of the microorganisms found in urine cultures (87.9%) were Gram-negative, being Escherichia coli (50.70%), followed by Klebsiella pneumoniae (23.1%) and Enterococcus spp. (9.7%). CONCLUSIONS: the findings of this investigation reveal the intrinsic association between risk factors and microorganisms for the development of urinary tract infection.

Infectious events in kidney transplant recipients from deceased expanded criteria donors: a prospective cohort.

OBJECTIVE: Analyze risk factors for infection in kidney transplant recipients from deceased expanded criteria donors (DECD) in the first two years of follow-up. METHOD: This is a prospective cohort study with 466 patients from DECD who underwent kidney transplantation in 2015 and 2016 in Brazil. A total of 551 events were recorded. The largest incidence of infectious events occurred in the first month after kidney transplantation. Cytomegalovirus infection was the most common infectious episode. RESULTS: The incidence rate of infections was 57.1%. Among bacterial infections, only 4% were due to multidrug-resistant microorganisms. The death rate was 3.3% (15) patients. The main cause of death was infectious (73.3%). Hospitalization until the first infection (aOR:1.61), Number of infections in 1 year (aOR:40.16), and Cytomegalovirus infection (aOR:13.84) was risk factors for infection by multidrug resistant microorganisms (MDR). CONCLUSION: Infection incidence with MDR bacteria was high among kidney transplant recipients from DECD, and the main cause of death was infection. Survival was high among patients with infection.

Evaluation of quality of life and depression in nursing technicians and nursing assistants.

The aim of this study was to evaluate the quality of life (QoL) and depression, and relate them to the sociodemographic characteristics of nursing technicians and nursing assistants in a private hospital. This was an epidemiological and cross-sectional study. The number of technicians and assistants who participated in this study was 266. The instruments used were the WHOQOL-BREF and the Beck Depression Inventory. The evaluation of quality of life of nursing technicians and assistants showed similar values to those found in individuals with chronic diseases. The presence of health problems led to higher indices of depression and lower QoL scores in the general and psychological domains and correlated to labor activity. Night-shift workers had higher scores of depression. Understanding factors, related to professional activities, which trigger health problems and alter quality of life, can provide tools in the search for alternatives to remedy or mitigate their effects.

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter.

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Acute Kidney Injury by SARS-CoV-2 virus in patients with COVID-19: an integrative review.

OBJECTIVE: to assess scientific evidence on SARS-CoV-2 Acute Kidney Injury in patients with COVID-19. METHODS: an integrative review, with adoption of PICO strategy and classification of the level of evidence, carried out on April 10, 2020 in the PubMed database, of articles available between December 2019 and April 2020. RESULTS: the sample consisted of six original, five observational and one experimental articles. Observational studies addressed the clinical findings of patients with COVID-19 and association between kidney damage, infection, and morbidity-mortality. CONCLUSION: the studies addressed the mechanism of intracellular infection of SARS-CoV-2, its cytopathic effects on kidney cells and incidence of acute kidney injury in patients infected with SARS-CoV-2. Acute kidney injury is associated with increased mortality and morbidity in these patients. This review realizes the need for new research that can mention kidney care to patients with COVID-19.

Contrast-Induced Nephropathy in patients submitted to percutaneous coronary intervention: an integrative review.

OBJECTIVE: to demonstrate scientific evidence on incidence and factors associated with contrast-induced nephropathy in patients undergoing percutaneous coronary intervention. METHODS: an integrative review carried out in the VHL, PubMed, VHL Regional Portal and SciELO databases, of articles published between 2014 and 2019. RESULTS: the sample consisted of five original articles, two cohorts, two control cases and a clinical trial. The incidence of contrast-induced nephropathy ranged from 6% to 24%. It stands out among patients with advanced age, male gender, diabetes mellitus, systemic arterial hypertension, volume of contrast infused and osmolarity. Intravenous hydration, sodium bicarbonate, ascorbic acid and statin were important prophylactic agents. CONCLUSION: this study envisioned the main risk factors for contrast-induced nephropathy in patients undergoing percutaneous coronary intervention and elucidated preventive measures that guide multidisciplinary health care aiming at a quality and safe care.

Quality of life and spirituality of patients with chronic kidney disease: pre- and post-transplant analysis.

OBJECTIVE: to compare the quality of life (QoL) of patients under dialysis and after kidney transplant; correlate the QoL of transplant patients to sociodemographic, morbid and spirituality/religiosity variables. METHOD: prospective study with a quantitative approach, with a sample of 27 patients who underwent peritoneal dialysis or dialysis undergoing kidney transplant. QoL and spirituality were assessed by the KDQOL-SF and WHOQOL-SRPB tools, being correlated with sociodemographic and economic variables. RESULTS: the dimensions of total mental component, kidney disease effects and kidney disease burden showed significant improvement in the post-transplant period, with p <0.0004. There was a significant correlation between four dimensions of spirituality and seven dimensions of QoL; p ranged from 0.04 to 0.006. CONCLUSION: there was a significant improvement in QoL in the post-transplant period. The dimensions of spirituality: wholeness and integration, spiritual connection, wonder and inner peace were positively correlated with seven dimensions of QoL.

Quality of life and body image of patients with urinary disorders.

OBJECTIVE: to assess the quality of life and body image of men with difficulty urinating and indwelling urinary catheter users, integrating the socio-demographic, economic and morbidity variables. METHOD: a cross-sectional analytical study with 64 male patients with urinary problems. Three questionnaires were used for data collection: one containing sociodemographic, economic and morbid data, the Medical Outcome Study 36-item short-form health survey to analyze quality of life, and the Body Dysmorphic Examination, which assesses body image. T-test, Mann-Whitney, Pearson, Spearman, Linear Regression and Stepwise were used. RESULTS: quality of life and body image were compromised in both groups, affecting emotional aspects, with a high degree of body dissatisfaction and altered physical and social adversity. CONCLUSION: changes in patients' quality of life and body image were observed, confirming the need for improvement in care.

Functional capacity and quality of life of elderly people admitted to emergency service. / Capacidade funcional e qualidade de vida de pessoas idosas internadas no serviço de emergência.

OBJECTIVE: To correlate the functional capacity and quality of life of elderly people admitted to emergency service. METHOD: This is a cross-sectional and analytical study carried out with elderly patients admitted to a university hospital's emergency service in the city of São Paulo, between December 2015 and January 2017. Data were collected through interviews using a structured questionnaire, the Medical Outcome Study 36, the Katz of Independence in Activities of Daily Living, and the Functional Independence Measure. RESULTS: Two hundred fifty elderly people with a mean age of 71.9 years, male (56.8%), white in color (67.2%), married (54.0%), with low education (32.0%), low income (58.0%), with comorbidities (81.2%) and home providers (53.6%) have participated. The most compromised Quality of Life dimensions were physical aspect (11.4%), emotional aspect (21.6%) and functional capacity (25.2%). Concerning functional capacity, independence was characterized for Basic Activities of Daily Living and moderate dependence for Instrumental Activities of Daily Living. The higher the scores of the Functional Independence Measure, the higher the quality of life scores. CONCLUSION: The more independent the elderly the better their quality of life.

Quality of life and cognitive and functional performance of octogenarians and nonagenarians undergoing hemodialysis.

OBJECTIVE: To evaluate the quality of life, cognitive and functional capacity of older adult patients undergoing hemodialysis who are 80 years of age or older and compare them to older adults without chronic kidney disease (CKD) treated at a geriatrics outpatient clinic. METHOD: First, 103 older adult patients undergoing hemodialysis and 103 older adults without CKD matched by gender and age were evaluated. Cognitive aspects as evaluated by the mini mental state examination, the Boston Naming Test and verbal fluency were analyzed; comorbidities according to the Charlson's comorbidity index; social support through the Medical Outcomes Study scale; functional ability through the chair sit-to-stand and gait speed tests, as well as the basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and quality of life according to the Kidney Disease Quality of Life Short Form (KDQOL SF-36) questionnaires. RESULTS: The hemodialysis group had a higher rate of comorbidities (7.8 ± 2.4 vs. 5.8 ± 2.3, p < 0.001). In the multiple logistic regression analysis, the group undergoing hemodialysis presented a ninefold greater chance of dependence for IADL than controls, a 4.3 and 3.2 times greater chances for inadequacy on the gait speed and chair sit-to-stand tests, respectively, as well as a 4.4-fold higher risk of cognitive decline on the verbal fluency test. CONCLUSION: Long-lived patients undergoing hemodialysis presented worse quality of life and functional and cognitive performance compared to long-term patients attended at the outpatient clinic, indicating that preventive and protective measures should be considered and implemented.