RESUMEN
Campylobacteriosis is caused by Gram bacteria. Most common species are C. jejuni and C. coli. Campylobacteriosis is a rare cause of sepsis, and in some European countries it is more common than salmonellosis, becoming a public health problem. We have treated a 66-year-old patient, hypertensive, ischemic cardiopathic, scheduled for coronary angiography, hospitalized with AKI, in a state of shock after some days of acute diarrhea. Because of the pathogen's seasonal nature and the patient's clinical features, in addition to common coproculture also Campylobacter has been sought, and found. Treated with volume repletion and antibiotics, within one week normal kidney functions were fully restored. He had a coronary angiography a week after being discharged from the hospital.
Asunto(s)
Infecciones por Campylobacter , Campylobacter , Anciano , Antibacterianos/uso terapéutico , Infecciones por Campylobacter/complicaciones , Infecciones por Campylobacter/diagnóstico , Infecciones por Campylobacter/tratamiento farmacológico , Diarrea/microbiología , Europa (Continente) , Humanos , MasculinoRESUMEN
Our Nephrology and Dialysis Unit includes three Haemodialysis Centres based in Savona, Albenga and Cairo Montenotte. These provide assistance to 150 patients. We have a Peritoneal Dialysis Clinic with 35 patients, two Post-Transplant Clinics with about 120 patients in follow-up in Savona and Albenga, and three Pre-Dialysis Clinics across the three locations. Finally, there is an autonomous hospital ward with 15 beds that has continued its activity, even if at reduced regimes. With this report we intend to share the strategy we used to prevent the spread of the SARS CoV-2 virus among the patients and the staff at our Unit, following the National, Regional and Corporate guidelines published during "Phase 1". We decided that the Haemodialysis Centres needed to remain a safe place. To insure this, medical and nursing staff and patients had to behave conscientiously and collaboratively, and according to the official Hospital guidance. Our main concern was to protect patients who, despite suffering complications and being at high risk because of their age, immunodepression and multiple comorbidities, were forced to leave their house three times a week to be treated with dialysis. The results of this strategy have ensured that, of the 150 patients undergoing haemodialysis, only 3 have been tested positive: no patients in Albenga, 2 in Savona and 1 in Cairo Montenotte, all of them lived and were infected in their nursing homes. Also, there was no positivity among any of the staff members across the three locations. Our results are extremely positive and confirm the validity that prevention and protection procedures had in the earlier stages of the pandemic.
Asunto(s)
COVID-19/epidemiología , Urgencias Médicas , Servicio de Urgencia en Hospital/organización & administración , Unidades de Hemodiálisis en Hospital/organización & administración , Fallo Renal Crónico/terapia , Pandemias , Diálisis Renal , SARS-CoV-2 , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/prevención & control , COVID-19/terapia , Prueba de COVID-19 , Comorbilidad , Manejo de la Enfermedad , Femenino , Unidades de Hemodiálisis en Hospital/estadística & datos numéricos , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Italia/epidemiología , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Cuarentena , Evaluación de SíntomasRESUMEN
We report the case of a 68-year-old patient who arrived at the hospital with a fever and a cough for 7 days, a history of high blood pressure and chronic kidney failure stage 2 according to CKD-EPI (GFR: 62 ml/minute with creatinine: 1.2 mg/dl). Home therapy included lercanidipine and clonidine. A chest radiograph performed in the emergency department immediately showed images suggestive of pneumonia from COVID-19, confirmed in the following days by a positive swab for coronavirus. Kidney function parameters progressively deteriorated towards a severe acute kidney failure on the 15th day, with creatinine values of 6.6 mg/dl and urea of 210 mg/dl. The situation was managed first in the intensive care unit with CRRT cycles (continuous renal replacement therapy) and then in a "yellow area" devoted to COVID patients, where the patient was dialyzed by us nephrologists through short cycles of CRRT. In our short experience we have used continuous techniques (CRRT) in positive patients hemodynamically unstable and intermittent dialysis (IRRT) in our stable chronic patients with asymptomatic COVID -19. We found CRRT to be superior in hemodynamically unstable patients hospitalized in resuscitation and in the "yellow area". Dialysis continued with high cut-off filters until the normalization of kidney function; the supportive medical therapy has also improved the course of the pathology and contributed to the favorable outcome for our patient. During the COVID-19 pandemic, our Nephrology Group at Savona's San Paul Hospital has reorganized the department to better manage both chronic dialyzed patients and acute patients affected by the new coronavirus.