Journal of Nephrology ( IF 2.7 ) Pub Date : 2021-08-03 , DOI: 10.1007/s40620-021-01115-w Mohamed Tayeb Salaouatchi 1 , Bhavna Mahadeb 2 , Philippe Clevenbergh 3 , Evelyne Maillart 3 , Maria Mesquita 1 , Irina Nechita 1 , Frederic Collart 1
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Background
Patients with end-stage-renal-disease (ESRD) undergoing hemodialysis (HD) represent a vulnerable population for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, due to their intrinsic fragility and increased exposure to the virus. Therefore, applying effective screening strategies and infection control measures is essential to control the spread of the epidemic within hemodialysis centers.
Objective
Description and evaluation of the efficacy of systematic screening by rt-PCR and viral cultures, in addition to triage to limit the spread of the epidemic. Evaluation of the performance of these tests using “post-hoc” SARS-CoV-2 serology as a surrogate marker of infection.
Methods
One hundred and forty-four patients undergoing hemodialysis in the Nephrology-Hemodialysis center of CHU Brugmann, Brussels, benefited from systematic virological screening using viral cultures in asymptomatic patients, or molecular tests (rt-PCR) for symptomatic ones, in addition to general prevention measures. Post-hoc serology was performed in all patients.
Results
Thirty-eight (26.3%) individuals were infected with SARS-CoV-2. Seventeen infected patients (44.7%) were asymptomatic and thus detected by viral culture. Our strategy allowed us to detect and isolate 97.4% of the infected patients, as proven by post-hoc serology. Only one patient, missed by clinical screening and sequential viral cultures, had a positive serology.
Conclusion
The implementation of a control and prevention strategy based on a systematic clinical and virological screening showed its effectiveness in limiting (and shortening) the spread of the SARS-CoV-2 epidemic within our hemodialysis unit.
Graphic abstract
中文翻译：
通过 PCR 和病毒培养进行系统性冠状病毒筛查以及分流在限制 SARS-CoV-2 在血液透析单元内传播方面的功效
背景
接受血液透析 (HD) 的终末期肾病 (ESRD) 患者是严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 感染的易感人群，因为他们固有的脆弱性和与病毒的接触增加。因此，应用有效的筛查策略和感染控制措施对于控制血液透析中心内流行病的传播至关重要。
客观的
描述和评估通过 rt-PCR 和病毒培养进行系统筛查的功效，以及分流以限制流行病的传播。使用“事后”SARS-CoV-2 血清学作为感染的替代标记来评估这些测试的性能。
方法
在布鲁塞尔 CHU Brugmann 的肾脏病-血液透析中心接受血液透析的 144 名患者除了一般预防外，还受益于在无症状患者中使用病毒培养物进行系统病毒学筛查，或对有症状患者进行分子检测 (rt-PCR)措施。对所有患者进行了事后血清学检查。
结果
38 人 (26.3%) 人感染了 SARS-CoV-2。17 名感染患者 (44.7%) 无症状，因此通过病毒培养检测。正如事后血清学所证明的那样，我们的策略使我们能够检测和隔离 97.4% 的感染患者。只有一名被临床筛查和连续病毒培养漏诊的患者血清学呈阳性。
结论
基于系统的临床和病毒学筛查的控制和预防策略的实施表明，它在限制（和缩短）我们血液透析单位内 SARS-CoV-2 流行病的传播方面是有效的。
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