The keys to control a COVID-19 outbreak in a haemodialysis unit
The keys to control a COVID-19 outbreak in a haemodialysis unit
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DOI：
10.1093/ckj/sfaa119
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发表时间：
2020-08-01
影响因子：
4.6
通讯作者：
Ramos, Rosa
中科院分区：
文献类型：
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作者：
Rincon, Abraham;Moreso, Francesc;Ramos, Rosa
背景。严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）的高传播率对血液透析（HD）单位构成了挑战。虽然快速隔离疑似病例对避免疾病暴发起着至关重要的作用，但最近已描述了无症状病例的显著比例。在我们的一个HD诊所发现疫情后，对确诊病例进行了广泛的SARS-CoV-2筛查和分离。对192例患者进行了实时逆转录酶聚合酶链反应检测。我们使用单变量和多变量逻辑回归来定义透析单元中涉及SARS-CoV-2感染的变量。随后，我们分析了有症状和无症状的sars - cov -2阳性患者之间的差异。共有22例有症状患者和14例无症状患者的sars - cov -2阳性结果。住在养老院/无家可归[比值比（OR） 3.54；P = 0.026]，前2周内入住参考医院（OR 5.19, P = 0.002），与未来有症状（OR 3.33, P = 0.013）和无症状（OR 4.73, P = 0.002）阳性患者共用医疗交通工具是检测阳性的独立危险因素。9例阳性患者（25.7%）在3周的随访后仍无症状。我们发现有症状和无症状的sars - cov -2阳性患者之间没有显著差异。发现无症状的sars - cov -2阳性患者可能是控制HD病房疫情的关键之一。共用去往透析室的医疗交通工具、住在养老院以及在过去两周内住过参考医院是感染SARS-CoV-2的主要危险因素。
Background. The high rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading represents a challenge to haemodialysis (HD) units. While fast isolation of suspected cases plays an essential role to avoid disease outbreaks, significant rates of asymptomatic cases have recently been described. After detecting an outbreak in one of our HD clinics, wide SARS-CoV-2 screening and segregation of confirmed cases were performed.Methods. The entire clinic population, 192 patients, underwent testing for SARS-CoV-2 detection by real-time reverse-transcriptase polymerase chain reaction. We used univariate and multivariate logistic regression to define variables involved in SARS-CoV-2 infection in our dialysis unit. Later, we analysed differences between symptomatic and asymptomatic SARS-CoV-2-positive patients.Results. In total, 22 symptomatic and 14 of the 170 asymptomatic patients had a SARS-CoV-2-positive result. Living in a nursing home/homeless [odds ratio (OR) 3.54; P = 0.026], having been admitted to the reference hospital within the previous 2 weeks (OR 5.19; P = 0.002) and sharing health-care transportation with future symptomatic (OR 3.33; P = 0.013) and asymptomatic (OR 4.73; P = 0.002) positive patients were independent risk factors for a positive test. Nine positive patients (25.7%) remained asymptomatic after a 3-week follow-up. We found no significant differences between symptomatic and asymptomatic SARS-CoV-2-positive patients.Conclusions. Detection of asymptomatic SARS-CoV-2-positive patients is probably one of the key points to controlling an outbreak in an HD unit. Sharing health-care transportation to the dialysis unit, living in a nursing home and having been admitted to the reference hospital within the previous 2 weeks, are major risk factors for SARS-CoV-2 infection.