Eliane Mikkelsen Ranivoharisoa
University of Madagascar, Madagascar
EM Ranivoharisoa received Bachelor’s degree with Scientific-option in 2002 ; studied human medicine in University of Madagascar and received Doctorate Degree in 2012 ; then studied internal medicine with nephrology orientation in the same University ; started nephrology training in Bordeaux- France in 2013 and has got Diploma of Specialized Medical Training in Nephrology in 2014 in France; studies also « Systemic disease and Kidney » with the University of Strasbourg, France. Nowadays, she has published some nephrology papers in national and international journals. She is member of SMN Madagascar, SFNDT and ISN education.
Patients with Chronic kidney Disease (CKD) are fragile. Hemodialysis, the most useful Renal Replacement Therapy (RRT) in the world is the only one treatment available in Madagascar. It is an invasive act that may expose various and several complications. This present study aims to assess the prevalence of the bacterial complication in patients who lived with chronic hemodialysis. We have conducted a retrospective, exhaustive, descriptive single center study. Record based study was carried in Befelatanana Hemodialysis Center, University Hospital of Antananarivo, the Capital of Madagascar. All patients underwent a chronic hemodialysis who presented an infection sign from 10th May 2006 to 31st July 2010 were included. The Center received 84 patients with End stage of CKD who started chronic hemodialysis. Over 136 infections have been suspected but only 33,8% (n= 45) benefited a bacterial identification. In 42.65% of cases, infection begun in 20 days following the first hemodialysis session. Access vascular using catheter is the principal source of infection in 49,06%, followed by pulmonary (21.3%), urinary (12.5%), and digestive (7.4%) infection. Staphylococcus aureus (34.3%), Escherichia coli (9,4%), Enterococcus spp (9,4%) were the bacteria frequently encountered. Sepsis appeared in 98.52% of cases and any patients presented a septic choc. All patients received an adjusted antibiotic therapy according to susceptibility testing. The survival rate was in 100%. Treatment of CKD is very expensive in Madagascar and less than 3% who need chronic hemodialysis have the opportunity to do it. That explains our few studied population. In our cohort, access vascular related to catheter represents the common source of infection (49.06%). This prevalence is higher than another american studies. Almost of all patients arrive lately at the hospital with an End-stage of CKD imposing starting hemodialysis in emergency with catheter. Another sources of infection have been seen in another sites. Patients can also contract infection independently of hemodialysis. Antibiotic therapy allowed a favorable evolution in almost of the cases. To conclude, using access vascular with catheter is inescapable in our center, inducing bacterial complication, high morbidity in Chronic Hemodialysis. To fix that, promoting native fistula with early nephrology medical follow could be a solution. Renal transplantation with living donor, the best and less expensive RRT than chronic hemodialysis is now in progress, in collaboration with Malagasy Government.