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1.
Anesth Analg ; 131(5): 1342-1354, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079853

RESUMO

Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2-infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2-infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance.


Assuntos
Anestesia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Exposição por Inalação/prevenção & controle , Intubação Intratraqueal , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aerossóis , Anestesia/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Contaminação de Equipamentos/prevenção & controle , Dispositivos de Proteção dos Olhos , Higiene das Mãos , Interações Hospedeiro-Patógeno , Humanos , Exposição por Inalação/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Segurança do Paciente , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Fatores de Proteção , Dispositivos de Proteção Respiratória , Medição de Risco , Fatores de Risco , Vestimenta Cirúrgica
2.
Am J Case Rep ; 21: e927452, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32973125

RESUMO

BACKGROUND COVID-19 is an infectious disease caused by SARS-CoV-2. It has spread rapidly through the world, endangering human life. The main target of COVID-19 is the lungs; however, it can involve other organs, including the liver. Patients with severe COVID-19 have an increased incidence of abnormal liver function, and patients with liver disorders are considered to be at a higher risk of severe COVID-19 infection. The mechanism of liver injury reported in 14% to 53% of COVID-19 patients is poorly recognized and several possibilities need to be considered (cytokine storm, direct viral action, hypoxia). The incidence of underlying liver comorbidities in patients with a COVID-19 infection ranges from 1% to 11%. CASE REPORT This is a report of 2 nosocomial COVID-19 infections and severe COVID-19 pneumonia in 2 patients who were hospitalized during treatment for alcoholic liver disease (ALD). Case 1 and case 2 were a 31-year-old woman and a 40-year-old woman, respectively, with decompensated ALD and symptoms of the COVID-19 infection. Both patients were transferred from another hospital to our hospital after confirmation of COVID-19 during their hospitalization. The course of the infection progressed rapidly in both patients with the development of multiple-organ failure and death over a short period. CONCLUSIONS There are no clear recommendations on the management of ALD in the COVID-19 pandemic. Alcoholic hepatitis may be a risk factor for severe COVID-19 and a poor outcome. A high percentage of nosocomial COVID-19 infections are observed; therefore, special precautions should be taken to minimize the risk of COVID-19 exposure.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/diagnóstico , Hepatopatias Alcoólicas/terapia , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Terapia Combinada , Infecções por Coronavirus/complicações , Infecção Hospitalar/terapia , Progressão da Doença , Evolução Fatal , Feminino , Hospitalização , Humanos , Hepatopatias Alcoólicas/diagnóstico , Insuficiência de Múltiplos Órgãos , Pandemias , Pneumonia Viral/complicações , Radiografia Torácica/métodos , Respiração Artificial , Medição de Risco
3.
Ann R Coll Surg Engl ; 102(7): e176-e179, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32803988

RESUMO

Spain has been one of the most affected countries by the COVID-19 outbreak. After the high impact of the pandemic, a wide clinical spectrum of late complications associated with COVID-19 are being observed. We report a case of a severe Clostridium difficile colitis in a post-treatment and recovered COVID-19 patient. A 64-year-woman with a one-month hospital admission for severe bilateral pneumonia associated with COVID-19 and 10 days after discharge presented with diarrhoea and abdominal pain. Severe C. difficile-associated colitis is diagnosed according to clinical features and CT findings. An urgent pancolectomy was performed due to her bad response to conservative treatment. Later evolution slowly improved to recovery. C. difficile-associated colitis is one of the most common hospital-acquired infections. Significant patient-related risk factors for C. difficile infection are antibiotic exposure, older age, and hospitalisation. Initial therapeutic recommendations in our country included administration broad-spectrum antibiotics to all patients with bilateral pneumonia associated with SARS-CoV-2. These antibiotics are strongly associated with C. difficile infection. Our patient developed a serious complication of C. difficile due to the use of broad-spectrum antibiotics. The appearance of late digestive symptoms in patients diagnosed and treated for COVID-19 should alert clinicians to the possibility of C. difficile infection. The updated criteria for severe colitis and severe C. difficile infection should be considered to ensure an early effective treatment for the complication.


Assuntos
Antibacterianos/uso terapêutico , Betacoronavirus , Clostridium difficile/isolamento & purificação , Colite/etiologia , Infecções por Coronavirus/complicações , Infecção Hospitalar/etiologia , Pneumonia Viral/complicações , Colite/tratamento farmacológico , Colite/microbiologia , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X
4.
Immun Inflamm Dis ; 8(4): 840-843, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32816387

RESUMO

INTRODUCTION: As an emerging infectious disease, coronavirus disease 2019 (COVID-19) has rapidly spread throughout worldwide. Health care workers (HCWs) on frontline directly participated in the diagnosis, treatment, and care of COVID-19 patients are at high risk of getting infected with the highly infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes COVID-19. In Nanjing Drum Tower Hospital, a total of 222 medical staff went to Wuhan city for support. In this study, we aimed to determine any nosocomial infection among our cohort of HCWs who worked in Wuhan. METHODS: Throat swab samples were obtained for RNA testing on day 1 and 14 of their quarantine upon their return to Nanjing. Radiological assessments were performed by chest computed tomography (CT) on day 14 of their quarantine. The blood was collected from 191 HCWs between May 12 and May 15. Anti-SARS-CoV-2 immunoglobulin M (IgM) and IgG antibody responses were determined by a chemiluminescence immunoassay. RESULTS: All the throat swab specimens were found negative for SARS-CoV-2. The radiological analysis revealed that there was no typical chest CT scan of COVID-19 among 222 HCWs. Consistently, anti-SARS-CoV-2 IgM or IgG was also found to be negative among 191 HCWs. CONCLUSIONS: There was no nosocomial infection of SARS-CoV-2 among our cohort of the frontline HCWs, suggesting that zero occupational infection is an achievable goal with appropriate training, strict compliance, and psychological support for the frontline HCWs.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus/patogenicidade , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Feminino , Humanos , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Pandemias/prevenção & controle , Faringe/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
BMC Infect Dis ; 20(1): 457, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600427

RESUMO

BACKGROUND: Indwelling central venous catheters (CVC) are used to provide long term hemodialysis. The commonest and the severe complication of CVC is the central line-associated bloodstream infection (CLABSI). This study was done to assess the etiology and infectious complications of CVC in children on long term hemodialysis. METHODS: Children newly undergoing hemodialysis and having indwelling CVC were included. They were followed up to a period of 2-years to assess infectious complications. Catheter bundle care approach was employed to prevent infections and other complications. Automated culture from the central catheter and peripheral vein and 2D echocardiography were done in each hemodialysis. Serial procalcitonin (PCT) was measured. Differential time of positivity (DTP) was used to detect CLABSI. During homestay in weekly telephone conversations were done to assess features of infection, and whenever having, we have asked to admit to the tertiary care unit. Logistic regression was performed, and the significant outcome variable was considered following multivariable analysis as a risk factor. RESULTS: Blood cultures were positive in 1090 (74.5%) out of 1462 children. According to DTP, 410 (28%) were having CLABSI, while 520 (35.6%) were having bacteremia without CLABSI. Out of 410 CLABSI patients, 79 (19.2%) were asymptomatic. Coagulase-negative Staphylococcus spp. (CoNS) bacteremia was significantly associated with asymptomatic CLABSI. Right-sided infective endocarditis (RS-IE) was significantly associated with asymptomatic CLABSI and asymptomatic bacteremia without CLABSI. CoNS was associated significantly in RS-IE following asymptomatic CLABSI and asymptomatic bacteremia. PCT was in asymptomatic CLABSI was 1.8 ± 0.9 ng/mL while in symptomatic CLABSI was 11.3 ± 2.5 ng/ml (P = 0.02). CoNS bloodstream infection, tunneled CVC, peripherally inserted central catheter, femoral site, the number of line days > 90, receipt of vancomycin, meropenem, or linezolid in the 5 days before CLABSI diagnosis and recurrent bacteremia were risk factors for asymptomatic CLABSI. CONCLUSIONS: Asymptomatic CLABSI could be a rare occurrence. CoNS was predominantly isolated in patients with asymptomatic CLABSI. RS- IE is a well-known complication in long term indwelling CVC. CoNS was significantly associated with RS-IE following asymptomatic CLABSI. Regular procalcitonin, microbiological, and imaging studies would be essential to detect infectious complications in both symptomatic and asymptomatic patients implanted with long term indwelling CVCs.


Assuntos
Doenças Assintomáticas , Bacteriemia/etiologia , Infecções Relacionadas a Cateter/diagnóstico , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Cateteres Venosos Centrais/microbiologia , Infecção Hospitalar/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Criança , Pré-Escolar , Coagulase/metabolismo , Infecção Hospitalar/sangue , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Endocardite/etiologia , Feminino , Seguimentos , Hospitais de Ensino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Fatores de Risco , Sri Lanka , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/enzimologia
8.
BMC Infect Dis ; 20(1): 539, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703263

RESUMO

BACKGROUND: Staphylococcus saccharolyticus is a rarely encountered coagulase-negative, which grows slowly and its strictly anaerobic staphylococcus from the skin. It is usually considered a contaminant, but some rare reports have described deep-seated infections. Virulence factors remain poorly known, although, genomic analysis highlights pathogenic potential. CASE PRESENTATION: We report a case of Staphylococcus saccharolyticus spondylodiscitis that followed kyphoplasty, a procedure associated with a low rate but possible severe infectious complication (0.46%), and have reviewed the literature. This case specifically stresses the risk of healthcare-associated S. saccharolyticus infection in high-risk patients (those with a history of alcoholism and heavy smoking). CONCLUSION: S. saccharolyticus infection is difficult to diagnose due to microbiological characteristics of this bacterium; it requires timely treatment, and improved infection control procedure should be encouraged for high-risk patients.


Assuntos
Infecção Hospitalar/diagnóstico , Discite/diagnóstico por imagem , Cifoplastia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus/isolamento & purificação , Vértebras Torácicas/microbiologia , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Coagulase/metabolismo , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Discite/tratamento farmacológico , Discite/microbiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus/enzimologia , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
10.
Stroke Vasc Neurol ; 5(3): 242-249, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32641446

RESUMO

During the COVID-19 epidemic, the treatment of critically ill patients has been increasingly difficult and challenging. During the epidemic, some patients with neurological diseases also have COVID-19, which could be misdiagnosed and cause silent transmission and nosocomial infection. Such risk is high in a neurological intensive care unit (NCU). Therefore, prevention and control of epidemic in critically ill patients is of utmost importance. The principle of NCU care should include comprehensive screening and risk assessment, weighing risk against benefits and reducing the risk of COVID-19 transmission while treating patients as promptly as possible.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/normas , Doenças do Sistema Nervoso/terapia , Neurologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Estado Terminal , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Interações Hospedeiro-Patógeno , Humanos , Doenças do Sistema Nervoso/diagnóstico , Saúde do Trabalhador , Segurança do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
Stroke ; 51(8): 2395-2403, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32586226

RESUMO

BACKGROUND AND PURPOSE: Infection occurs commonly in patients with acute ischemic stroke. We aimed to investigate the association of infection with short- and long-term risk of recurrent stroke in patients with ischemic stroke. METHODS: Data were derived from ischemic stroke patients in 2 stroke registries: the CSCA (Chinese Stroke Center Alliance) program recorded medical data during hospitalization, and the CNSR-III (Third China National Stroke Registry) recorded the medical data during hospitalization and finished 1-year follow-up. Associations of infection (pneumonia or urinary tract infection) during hospitalization with recurrent stroke in short (during hospitalization) and long term (since 30 days to 1 year after stroke onset) were analyzed. Short-term outcomes were analyzed with logistic models and long-term outcomes with Cox models. RESULTS: In the CSCA (n=789 596), the incidence of infection during hospitalization reached 9.6%. Patients with infection had a higher risk of stroke recurrence during hospitalization compared with patients without infection (10.4% versus 5.2%; adjusted odds ratio, 1.70 [95% CI, 1.65-1.75]; P<0.0001). In the CNSR-III (n=13 549), the incidence of infection during hospitalization was 6.5%. Infection during hospitalization was significantly associated with short-term risk of recurrent stroke (7.4% versus 3.9%; adjusted odds ratio, 1.40 [95% CI, 1.05-1.86]; P=0.02) but not with long-term risk of recurrent stroke (7.2% versus 5.2%; adjusted hazard ratio, 1.16 [95% CI, 0.88-1.52]; P=0.30). CONCLUSIONS: Infection was an independent risk factor for high risk of early stroke recurrence during hospitalization, but we have not found its sustained effect on long-term recurrent risk in patients with acute ischemic stroke.


Assuntos
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Sistema de Registros , Fatores de Risco
13.
Ann Thorac Surg ; 110(6): e461-e463, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32522632

RESUMO

The novel coronavirus disease 2019 is a highly contagious viral infection caused by the severe acute respiratory syndrome coronavirus 2 virus. Its rapid spread and severe clinical presentation influence patient management in all specialties including thoracic surgery. We report 3 cases of coronavirus disease 2019 occurring in patients shortly after thoracotomy and thoracoscopy procedures, illustrating the imminent threat of severe acute respiratory syndrome coronavirus 2 infection for thoracic surgery patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/diagnóstico , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Pneumonia Viral/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/terapia , Infecção Hospitalar/etiologia , Infecção Hospitalar/terapia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Toracoscopia/efeitos adversos , Toracotomia/efeitos adversos
14.
BMC Infect Dis ; 20(1): 398, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503450

RESUMO

BACKGROUND: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures. METHODS: We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. RESULTS: We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient's onset (ORadj = 34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an "isolation" ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. CONCLUSIONS: This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.


Assuntos
Sarampo/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Infecção Hospitalar/diagnóstico , Surtos de Doenças , Feminino , Hospitais Pediátricos , Humanos , Imunoglobulina M/sangue , Lactente , Masculino , Sarampo/epidemiologia , Morbillivirus/imunologia , Uganda/epidemiologia , Cobertura Vacinal
19.
Am J Kidney Dis ; 75(5): 665-683, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32279907

RESUMO

The first KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection was published in 2008. The ensuing decade bore witness to remarkable advances in the treatment of HCV infection following the approval of direct-acting antiviral (DAA) agents that deliver cure rates routinely >95%. In this context, the KDIGO organization correctly recognized the need for an updated HCV guideline that would be relevant to the treatment of HCV-infected patients with kidney disease in the DAA era. The current NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) commentary provides an in-depth review and perspective on the 2018 KDIGO guideline. Of note, the KDIGO work group made significant updates to guideline chapters 2 and 4 as a direct result of the availability of DAAs. The intent of this commentary is to provide useful interpretation for nephrologists and other practitioners caring for HCV-infected patients with chronic kidney disease, including dialysis patients and kidney transplant recipients. The availability of DAA agents that are safe and highly effective has created new opportunities, such as the transplantation of kidneys from HCV-infected kidney donors. The ability to treat HCV infection in patients with kidney disease will have a significant impact on the care of our patients and should favorably influence long-term outcomes as well.


Assuntos
Hepatite C , Guias de Prática Clínica como Assunto , Antivirais/farmacologia , Antivirais/uso terapêutico , Infecção Hospitalar/diagnóstico , Gerenciamento Clínico , Seleção do Doador , Diagnóstico Precoce , Contaminação de Equipamentos , Previsões , Genótipo , Hepacivirus/genética , Hepatite B/complicações , Hepatite B/diagnóstico , Hepatite C/complicações , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/prevenção & controle , Humanos , Controle de Infecções/métodos , Transplante de Rim , Cirrose Hepática/diagnóstico , Cirrose Hepática/etiologia , Programas de Rastreamento , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Pesquisa
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