Ultrasound meal accommodation test in critically ill patients with and without feeding intolerance UMAT-ICU.

BACKGROUND: Gastrointestinal dysfunction (GID) is one of the leading causes of nonavoidable discontinuing or delayed enteral feeding in critically ill patients. The ultrasound meal accommodation test (UMAT) has been used in ambulatory patients to evaluate dyspepsia. The objective of this study was to determine differences in the UMAT scores of critically ill patients with and without feeding intolerance (FI). METHODS: A prospective, observational, two-centre study was conducted between June and August 2019. We included subjects who met the criteria for enteral nutrition. Patients and their subrogates provided signed consent for intervention. The independent variables were cross-sectional area (CSA) and calculated gastric volume (CGV). Dependent variables were changes in the UMAT at Time 1 and Time 2 and gastric residue in those with and without FI. After that, patients were divided into two groups, depending on the development of GID over the following 48 h after inclusion in the study group A, subjects without FI; and group B, subjects with FI. According to the normal distribution in parametric or non-parametric tests. Differences between groups were determined using a Student's T-test. A p-value of ≤0.05 was established for the statistical difference between groups. At 60 min, a change cut-off point of 52% has a sensitivity of 50%, specificity of 88.9%, a positive likelihood ratio of 4.50 and a negative likelihood ratio of 0.56. With a pretest probability of 85% for feeding tolerance in intensive care unit patients, the posttest probability increased to 96% with a positive test with the ΔCSA. RESULTS: 61 patients were included in the study; 52 (85%) in Group A and 9 (15%) in Group B. However, at time 0 (fasting), there were statistical differences in CSA and CGV between groups (p = 0.001). During Time 1 (dynamic changes), there were statistical differences between the groups (p = 0.008 for CSA and p = 0.011 for CGV). At time 3 (Delta), there were statistical differences between groups at minute 10 (p = 0.023 for CSA and p = 0.008 for CGV). CONCLUSION: Our study showed statistical differences in the UMAT test between patients with and without FI. TRIAL REGISTRATION: Clinical trials registry NCT03851354. February 22, 2019.

Enfisema subcutáneo extenso / Extensive subcutaneous emphysema / Enfisema subcutâneo extenso

Resumen: El enfisema subcutáneo es una complicación relativamente frecuente y por lo general autolimitada tras la colocación de un tubo de toracostomía. El enfisema subcutáneo relacionado con la ventilación mecánica a presión positiva puede condicionar tensión subcutánea palpable (aumento de volumen y crepitación subcutánea), cierre palpebral, disfagia, disfonía y, asociado con pneumoperitoneo, compromiso de la vía aérea e insuficiencia respiratoria «fenómeno de tensión¼ clasificándolo por estas características como enfisema subcutáneo extenso.

Abstract: Subcutaneous emphysema is common complication self-limited complication of tube thoracostomy. Any subcutaneous emphysema on positive pressure ventilation, causing palpable cutaneous tension, palpebral closure, dysphagia, and dysphonia or associated with pneumoperitoneum, airway compromise, «tension phenomenon¼ and respiratory failure is labelled extensive subcutaneous emphysema.

Resumo: O enfisema subcutâneo é uma complicação relativamente comum e geralmente autolimitada após a colocação de um tubo de toracostomia. O enfisema subcutâneo relacionado à ventilação mecânica com pressão positiva pode levar a tensão subcutânea palpável (aumento de volume e crepitação subcutânea), fechamento da pálpebra, disfagia, disfonia; associado a pneumoperitônio, comprometimento das vias aéreas e insuficiência respiratória «fenômeno tensional¼ classificando-o por essas características como enfisema subcutâneo extenso.

Secondary sclerosing cholangitis in critically ill patients.

Primary sclerosing cholangitis (PSC) is a rare idiopathic condition with immunopathogenic mechanisms where there is chronic progressive destruction of the biliary tree. Secondary sclerosing cholangitis (SSC) is clinically comparable to PSC, but is caused by specific processes which directly damage the biliary tree; examples include recurrent pancreatitis, bile duct malignancy, congenital bile duct abnormalities. A new cause of SSC has been described during or following significant critical illness associated with severe respiratory insufficiency, vasopressor requirement, shock and sepsis. This condition rapidly progresses to cirrhosis, frequently requiring liver transplantation for definitive management.

La colangitis esclerosante primaria (CEP) es una condición idiopática rara con mecanismos inmunopatogénicos en la que existe una destrucción crónica y progresiva del árbol biliar. La colangitis esclerosante secundaria (CES) es clínicamente comparable a la CEP, pero está causada por procesos específicos que dañan directamente el árbol biliar; ejemplo de esto son enfermedades como la pancreatitis recurrente, las neoplasias de la vía biliar y las anomalías congénitas de la vía biliar, entre otras. Una nueva causa de CES ha sido descrita durante o después de una enfermedad crítica, en muchas ocasiones relacionada con las intervenciones de soporte o con condiciones de ingreso propias de la unidad de terapia intensiva, como son la ventilación mecánica invasiva, los vasopresores, el estado de choque y la sepsis. Esta condición progresa rápidamente a cirrosis, y con frecuencia requiere un trasplante de hígado para su manejo definitivo.

Hipotermia terapéutica controlada. Experiencia en un Hospital de Tercer Nivel / Therapeutic hypothermia. Experience in a Third Level Hospital / Hipotermia terapêutica controlada experiência em um hospital de alta complexidade

Resumen: Objetivo: Presentar la experiencia relacionada a hipotermia terapéutica controlada en pacientes graves que presentaron lesión neurológica aguda. Material y métodos: Estudio clínico, retrospectivo, observacional y descriptivo, en el Departamento de Medicina Crítica de Adultos de un Hospital de Tercer Nivel en un periodo comprendido del 01 de enero de 2016 al 31 de julio de 2017. Pacientes llevados a hipotermia terapéutica. Resultados: Cinco pacientes incluidos en el estudio, con una media de edad de 52.4 años, 80% con padecimientos neurocríticos. El promedio de estancia en la UCI fue de 15.2 días, y de hospitalización 63 días. La media de días de ventilación mecánica fue de 13.8 días. Sesenta porciento de los pacientes desarrolló neumonía asociada a la ventilación mecánica. Cuarenta porciento de los pacientes presentó una discapacidad grave. Conclusiones: La hipotermia terapéutica en el grupo estudiado no impactó de manera positiva en los desenlaces neurológicos. La complicación más frecuente fue la neumonía asociada a la ventilación mecánica.

Abstract: Objective: To present the experience related to controlled therapeutic hypothermia in severe patients who presented acute neurological injury. Material and methods: Clinical, retrospective, observational and descriptive study in the Department of Critical Care of Adults of a Hospital of Third Level in a period between January 1, 2016 and July 31, 2017. Patients taken to therapeutic hypothermia. Results: Five patients included in the study, with a mean age of 52.4 years, 80% with neurocritical conditions. The average stay in the ICU was 15.2 days, and hospitalization was 63 days. The mean number of days of mechanical ventilation was 13.8 days. Sixty percent of patients developed ventilator-associated pneumonia. Forty percent of the patients had a severe disability. Conclusions: Therapeutic hypothermia in the study group did not positively impact neurological outcomes. The most frequent complication was ventilator-associated pneumonia.

Resumo: Objetivo: Apresentar a experiência relacionada à hipotermia terapêutica controlada em pacientes graves que apresentaram lesão neurológica aguda. Material e métodos: Estudo clínico, retrospectivo, observacional e descritivo, no Departamento de Medicina Crítica de adultos, no período de 1 de janeiro de 2016 a 31 de julho de 2017. Pacientes submetidos à Hipotermia Terapêutica. Resultados: Foram incluídos no estudo 5 pacientes com idade média de 52.4 anos, 80% com alterações neurológicas. A permanência média na UTI foi de 15.2 dias e de hospitalização 63 dias. A média de dias de ventilação mecânica foi de 13.8. 60% dos pacientes desenvolveram pneumonia associada à ventilação mecânica. 40% dos pacientes tinham um incapacidade grave. Conclusões: A hipotermia terapêutica no grupo estudado não teve impacto positivo nos desfechos neurológicos. A complicação mais frequente foi pneumonia associada à ventilação mecânica.

Secondary sclerosing cholangitis in critically ill patients. / Colangitis esclerosante secundaria en pacientes críticamente enfermos

Primary sclerosing cholangitis (PSC) is a rare idiopathic condition with immunopathogenic mechanisms where there is chronic progressive destruction of the biliary tree. Secondary sclerosing cholangitis (SSC) is clinically comparable to PSC, but is caused by specific processes which directly damage the biliary tree; examples include recurrent pancreatitis, bile duct malignancy, congenital bile duct abnormalities. A new cause of SSC has been described during or following significant critical illness associated with severe respiratory insufficiency, vasopressor requirement, shock and sepsis. This condition rapidly progresses to cirrhosis, frequently requiring liver transplantation for definitive management.

La colangitis esclerosante primaria (CEP) es una condición idiopática rara con mecanismos inmunopatogénicos en la que existe una destrucción crónica y progresiva del árbol biliar. La colangitis esclerosante secundaria (CES) es clínicamente comparable a la CEP, pero está causada por procesos específicos que dañan directamente el árbol biliar; ejemplo de esto son enfermedades como la pancreatitis recurrente, las neoplasias de la vía biliar y las anomalías congénitas de la vía biliar, entre otras. Una nueva causa de CES ha sido descrita durante o después de una enfermedad crítica, en muchas ocasiones relacionada con las intervenciones de soporte o con condiciones de ingreso propias de la unidad de terapia intensiva, como son la ventilación mecánica invasiva, los vasopresores, el estado de choque y la sepsis. Esta condición progresa rápidamente a cirrosis, y con frecuencia requiere un trasplante de hígado para su manejo definitivo.

Standardization of Sonographic Diaphragm Thickness Evaluations in Healthy Volunteers.

BACKGROUND: B-mode ultrasound can be used to measure diaphragm thickness at the zone of apposition. We believe it is necessary to develop normal values for diaphragm thickness at rest in a large group of healthy subjects and compare them with international results. METHODS: Ultrasound measurements of diaphragm thickness at expiratory rest were taken in 109 healthy individuals, with results stratified by sex, body mass index, and thorax circumference. The following methods were used for analysis and interpretation. Multivariable databases with descriptive statistical analyses were made. The Pearson chi-square test was used to evaluate the distribution between variables. Additionally, mean and SD values were calculated. For standardization, the data were separated by sex within a 95% CI, and we calculated a Z test. A 95% CI was also constructed for proportion analyses. RESULTS: One hundred nine healthy volunteers were included in the study, and the correlation between the body mass index and thorax circumference values with a Pearson chi-square test resulted in an r = 0.69. Additionally, the average value of diaphragmatic thickness was 0.19 ± 0.04 cm (95% CI 0.17-0.20 cm) for men and 0.14 ± 0.03 cm (95% CI 0.13-0.15 cm) for women (P = .001). There was no relation between body mass index thorax circumference, and diaphragmatic thickness. CONCLUSION: Real-time ultrasound of the diaphragm is a simple, inexpensive, and portable imaging technique that can provide qualitative anatomical information. The findings in this study show that sonographic diaphragm evaluations can be applied to the general population.

Especies reactivas de oxígeno, sepsis y teoría metabólica del choque séptico / Reactive oxygen species, sepsis and metabolic theory of the septic shock

Resumen La sepsis es una de las principales causas de mortalidad en la unidad de terapia intensiva. El término especies reactivas de oxígeno (ERO) incluye moléculas con un electrón impar, llamadas radicales libres, como el anión superóxido, y también agentes oxidados como el peróxido de hidrógeno. Las ERO pueden reaccionar con muchas moléculas y pueden producir un daño no controlado; sin embargo, también tienen un papel fundamental en el metabolismo celular. El estrés oxidante es el resultado de la respuesta inflamatoria asociada a la sepsis que produce cambios en la función mitocondrial y en la microcirculación. El objetivo de este trabajo es revisar el papel de las ERO en sepsis y nuevos conceptos relacionados con la teoría metabólica del choque séptico.

Abstract Sepsis remains the most common cause of death in the intensive care unit. The term Reactive Oxygen Species (ROS) includes molecules with an unpaired electron, called free radicals, such as superoxide anion, and also oxidant agents such as hydrogen peroxide. ROS can react with several molecules and induce an uncontrolled damage in a variety of biomolecules. On the other hand, ROS have essential roles in cell function. Marked oxidative stress as a result of the inflammatory responses inherent with sepsis initiates changes in mitochondrial function and microcirculation. The aim of this paper is to review the roll of ROS in sepsis and new concepts related to the metabolic theory of septic shock.

Efectos fisiológicos en un ambiente de microgravedad / Physiological effects in an environment of microgravity

Resumen En el siglo veinte, el estudio del universo y el desarrollo de los vuelos espaciales fueron posibles gracias al avance tecnológico de naves de propulsión por diferentes tipos de cohetes. Muchos sistemas biológicos se afectan en los vuelos espaciales y se ha demostrado que en un ambiente de microgravedad se altera de manera significativa la función musculoesquelética, neurosensitiva, endócrina, renal, respiratoria y cardiovascular, además del riesgo de lesión debido a la exposición a diferentes tipos de radiación, eventos que comprometen la salud y rendimiento de los astronautas. Por lo anterior es fundamental mantener la salud y acondicionamiento físico de los astronautas durante el vuelo espacial para facilitar y acelerar su recuperación al llegar a la tierra.

Abstract Until the twentieth century, study about the universe and speculation about the nature of spaceflight were no closely related to the technical developments that led to rocket propulsión. Many biological systems are adversely affected by space flight and It has been shown that exposure to microgravity can alter the musculoskeletal, neurosensory, endocrine, renal, respiratory and cardiovascular systems and the risk of injury due to radiation exposure resulting in deconditioning that may compromise astronauts health and performance. Maintainig health and fitness during space missions is critical for preserving performance during misión specific tasks and to optimize terrestrial recovery.

Bases moleculares de la sepsis / Molecular basis of sepsis

Resumen La sepsis es un síndrome que continúa siendo una causa importante de morbilidad y mortalidad entre los pacientes críticamente enfermos. Pese al desarrollo de la investigación básica dedicada al tema y los numerosos ensayos clínicos, no se han logrado avances notables en el desarrollo de terapias vanguardistas y eficaces para su manejo. Los trastornos fisiológicos inducidos por la sepsis son en gran parte debidos a la respuesta del huésped a los microorganismos invasores en contraste con los efectos directos del propio microorganismo. La sepsis, entendida como la respuesta inflamatoria sistémica a la infección, está marcada por la producción desregulada de citocinas proinflamatorias. Estos mediadores conducen de manera colectiva a la insuficiencia orgánica múltiple, y en última instancia, a la muerte. Es en este sentido que el papel de la inflamación en la fisiopatogenia de la sepsis, aunque todavía no entendida completamente, resulta claramente crítico. Esta revisión proporciona una perspectiva de las diversas interacciones moleculares que ocurren durante la sepsis, con el intento de poder comprender la naturaleza de la respuesta desregulada del sistema inmunitario durante ésta.

Abstract Sepsis continues to be a primary cause of high mortality and morbidity in critically ill patients. Despite constant growth in dedicated basic investigation and numerous clinical studies, no remarkable developments have been made for effective and innovative therapies. The physiologic disorders induced by sepsis are primarily due to the overwhelming immune response to invading pathogens rather than the direct effects caused by the pathogen. Sepsis, understood as the systemic inflammatory response to infection is characterized by the unregulated production of proinflammatory cytokines. These mediators collectively lead to multiple organ failure and eventually to death. In this context, the role of inflammation in the physiopathology of sepsis, though not fully understood, is of critical importance. This review provides a perspective of the most current understandings of the molecular mechanisms during sepsis, which may provide an attempt to understand the nature of this unregulated response of the immune systems during sepsis.

Síndrome de sepsis grave postesplenectomía secundario a meningococcemia / Overwhelming postsplenectomy infection (OPSI) syndrome secondary to meningococcemia

Resumen Los pacientes esplenectomizados o con hipoesplenia son susceptibles a desarrollar infecciones y sepsis grave. A esta entidad se le denomina sídrome de sepsis postesplenectomía (SSPE). Reportamos el caso de una paciente que presentó SSPE secundario a Neisseria meningitidis serogrupo CR7, 10 años después de practicársele esplenectomía por púrpura trombocitopénica idiopática. El SSPE tiene una elevada mortalidad, su evolución es fulminante, las manifestaciones son graves y el pronóstico es malo. Es fundamental que los pacientes esplenectomizados sean vacunados, reciban antibióticos profilácticos y atención médica ante cualquier manifestación de un proceso infeccioso. Es prioritario implementar una política de salud pública para el desarrollo de guías relacionadas al seguimiento de los pacientes esplenectomizados y sobre la profilaxis, diagnóstico y manejo del SSPE, y difundir entre los pacientes esplenectomizados y con disfunción esplénica así como al grupo médico tratante programas educacionales relacionados con esta enfermedad.

Abstract Patients with splenectomy or splenic dysfunction are likely to suffer from severe infections and sepsis. This syndrome is called overwhelming postsplenectomy infection (OPSI). We present the case of an adult who developed OPSI syndrome secondary to Neisseria meningitidis serogroup CR 7, ten years after being splenectomized due to idiopathic thrombocytopenic purpura. OPSI syndrome has a high mortality. Its course is fulminating, the clinical symptoms are serious and the prognosis is poor. It is important for splenectomized patients to receive immunizations, antibiotic prophylaxis and seek medical attention at the earliest sign of minor infection. Public health politics should be implemented for the development of guidelines related to the monitoring of splenecto-mized patients and prophylaxis, diagnosis and treatment of OPSI syndrome and make reliable information on this disease available to patients and physicians.

[Ultrasonographic evaluation of the diameter of the optic nerve sheath for medication of intracranial pressure: a case report]. / Evaluación ultrasonográfica del diámetro de la vaina del nervio óptico (DVNO) para la medición de la presión intracraneana (PIC): a propósito de un caso.

The main complication associated with acute brain injury is the elevation of intracranial pressure (ICP) and it is associated with high morbidity and mortality. In these patients, multimodal neurological monitoring has emerged as a fundamental tool in the intensive care unit, with the minimally invasive trend seen in recent years. We report the case of a patient in which ICP monitoring was based on the measurement of the diameter of the optic nerve sheath (DONS), a procedure that has shown a good correlation with the ICP, as well as a high specificity, sensitivity, and low cost.

[Liver abscess syndrome with lung involvement secondary to hypermucoviscosity Klebsiella pneumoniae]. / Síndrome de absceso hepático secundario a Klebsiella pneumoniae hipermucoviscosa con involucro pulmonar.

Klebsiella pneumoniae liver abscess syndrome (KLAS) is an emerging infection characterized by primary monomicrobial liver abscess, bacteremia and metastatic complications. KLAS is endemic in Taiwan but additional cases has also been described in other world regions. It's caused by strains of K. pneumonia serotype K1, rmpA, magA positive, displaying hypermucoviscosity. We present the case of a previously healthy 69 years old patient who developed fever, liver abscess,septic shock, bacteremia, and pneumonia. In cultures grew hypermucoviscous phenotype of K. pneumonia characterized by positive "string test". The patient responded favourably to antibiotic therapy with ceftriaxone, meropenem, amykacin and percutaneous drainage of the abscess. Increased awareness about this globally emerging infection by physicians could allow earlier detection and optimal treatment.

Colecistectomía videolaparoscópica de urgencia en el paciente geriátrico / Videolaparoscopy emergency cholecystectomy in the elderly

Objetivo: describir el comportamiento de pacientes con 60 y más años de edad sometidos a colecistectomía videolaparoscópica de urgencia. Métodos: se realizó un estudio observacional descriptivo, longitudinal y retrospectivo de los 91 pacientes con 60 y más años de edad sometidos a dicho proceder, en el período comprendido desde enero de 2001 hasta diciembre de 2008, en el servicio de cirugía general del Hospital Clinicoquirúrgico Lucía Íñiguez Landín de Holguín. Resultados: el paciente geriátrico constituyó el 26 por ciento de los enfermos sometidos a este procedimiento, y más del 70 por ciento correspondió al grupo de la tercera edad (60-75 años), con un predominio del sexo femenino. El 21,9 por ciento de los pacientes presentaba enfermedades asociadas, y fue la hipertensión arterial la más frecuente. La intervención requirió hasta 60 min en el 70,3 por ciento de los pacientes; el índice de conversión fue de 6,5 por ciento, la morbilidad de 3,2 por ciento y la mortalidad de 1 por ciento. Conclusiones: la colecistectomía videolaparoscópica de urgencia en el paciente geriátrico puede realizarse exitosamente(AU)

Objective: to describe the behavior of patients aged 60 and more underwent to videolaparoscopy emergency cholecystectomy. Methods: a retrospective, longitudinal and descriptive study was conducted in 91 patients aged 60 and more underwent to such procedure from January, 2001 to December, 2008 in the general service of Lucía Iñiguez Landín Hospital of Holguín province. Results: elderlies were the 26 percent of patients underwent to this procedure and more than 70 percent correspondent to the third age group (60-75 years) with predominance of female sex. The 21.9 percent of patients had associated diseases where the high blood pressure was the more frequent one. The intervention time was of 60 min in the 70,3 percent of patients; the conversion rate was of 6,5 percent, morbidity was of 3,2 percent and mortality was of 1 percent. Conclusions: emergency videolaparoscopy cholecystectomy in elderly may be successfully done(AU)

Colecistectomía videolaparoscópica de urgencia en el paciente geriátrico / Videolaparoscopy emergency cholecystectomy in the elderly

Objetivo: describir el comportamiento de pacientes con 60 y más años de edad sometidos a colecistectomía videolaparoscópica de urgencia. Métodos: se realizó un estudio observacional descriptivo, longitudinal y retrospectivo de los 91 pacientes con 60 y más años de edad sometidos a dicho proceder, en el período comprendido desde enero de 2001 hasta diciembre de 2008, en el servicio de cirugía general del Hospital Clinicoquirúrgico Lucía Íñiguez Landín de Holguín. Resultados: el paciente geriátrico constituyó el 26 por ciento de los enfermos sometidos a este procedimiento, y más del 70 por ciento correspondió al grupo de la tercera edad (60-75 años), con un predominio del sexo femenino. El 21,9 por ciento de los pacientes presentaba enfermedades asociadas, y fue la hipertensión arterial la más frecuente. La intervención requirió hasta 60 min en el 70,3 por ciento de los pacientes; el índice de conversión fue de 6,5 por ciento, la morbilidad de 3,2 por ciento y la mortalidad de 1 por ciento. Conclusiones: la colecistectomía videolaparoscópica de urgencia en el paciente geriátrico puede realizarse exitosamente(AU)

Objective: to describe the behavior of patients aged 60 and more underwent to videolaparoscopy emergency cholecystectomy. Methods: a retrospective, longitudinal and descriptive study was conducted in 91 patients aged 60 and more underwent to such procedure from January, 2001 to December, 2008 in the general service of Lucía Iñiguez Landín Hospital of Holguín province. Results: elderlies were the 26 percent of patients underwent to this procedure and more than 70 percent correspondent to the third age group (60-75 years) with predominance of female sex. The 21.9 percent of patients had associated diseases where the high blood pressure was the more frequent one. The intervention time was of 60 min in the 70,3 percent of patients; the conversion rate was of 6,5 percent, morbidity was of 3,2 percent and mortality was of 1 percent. Conclusions: emergency videolaparoscopy cholecystectomy in elderly may be successfully done(AU)

Fragilidad y sarcopenia / Frailty and sarcopenia

La fragilidad es un síndrome geriátrico caracterizado por pérdida de peso, cansancio, debilidad, marcha lenta y disminución de la actividad física. Es más común en mujeres, obesos y diabéticos. Es secundaria a disregulación endócrina y a un estado proinflamatorio y protrombótico. La sarcopenia, pérdida de la masa muscular, es característica de la fragilidad. El tratamiento está encaminado a incrementar la masa y fuerza muscular mediante un mejor aporte calórico-protéico y un programa de ejercicios. El presente trabajo tiene como objetivo revisar conceptos actuales relacionados a la definición, epidemiología, fisiopatología y tratamiento del síndrome de fragilidad y la sarcopenia, así como su impacto en la población geriátrica.

Frailty is a geriatric syndrome characterized by weight loss, fatigue, weakness, slow walking and reduced physical activity. It is more common among women, obese people and diabetic patients. It is secondary to endocrine dys-regulation and a proinflammatory, prothrombotic status. Sarcopenia, loss of muscle mass, is characteristic of frailty. The treatment is focused on increasing muscle mass and strength by improving caloric-proteic intake and implementing a physical exercise program. The aim of the present article is to review the current concepts related to the definition, epidemiology, pathophysiology and treatment of frailty syndrome and sarcopenia, as well as its impact on geriatric population.

[Severe sepsis, septic shock and secondary multiple organ dysfunction in infection by Kluyvera ascorbata]. / Sepsis grave, choque séptico y disfunción orgánica múltiple secundaria a infección por Kluyvera ascorbata.

Kluyvera, a new genus of Enterobacteriaceae, is an emergent pathogen. Kluyvera species have been isolated from sputum, urine, stools, and blood. Kluyvera strains are infrequent but potentially dangerous pathogens in the immunocompetent or immunocompromised host due to their potential to provoke a wide range of infections and their ability to transfer extended spectrum beta lactamase genes. We herein report the case of a teenage male with severe sepsis and septic shock due to K. ascorbata.