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2.
Ren Fail ; 44(1): 2010-2018, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36408926

RESUMO

OBJECTIVE: To investigate the different impacts on clinical outcomes between regular recall and non-regular recall among incident peritoneal dialysis (PD) patients. METHODS: A two-center cohort of 216 new PD patients from 1January 2013, to 31 December 2014, was studied. Informative clinical data were collected from baseline until two years after PD initiation, including demographics, laboratory and PD-related parameters, PD-related peritonitis rates, and frequency of hospitalization. Regular in-person recall (RPR) was defined as having a one-month interval and non-regular in-person recall (NRPR) as an interval ranging from more than one month to less than three months. RESULTS: Percentage of patients with peritonitis was significantly higher among patients in the NRPR group than among those in the RPR group (27.7% vs. 16.5%, p = .049). PD-related peritonitis rate was higher in the NRPR vs. RPR cohorts (0.16 vs. 0.09 person/year, p = .019). PD-related hospitalization frequency was also higher in the NRPR cohort (0.8 ± 1.0 vs. 0.5 ± 0.9, p = .039) over two years. Kt/V values in the NRPR cohort gradually decreased over two years and were at lower levels than in the RPR cohort. CONCLUSIONS: New PD patients with NRPR showed higher rates of PD-related peritonitis and hospitalization frequency than patients with RPR.


Assuntos
Diálise Peritoneal , Peritonite , Humanos , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Peritonite/etiologia , Estudos de Coortes , Hospitalização
4.
Ren Fail ; 44(1): 1623-1631, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36195979

RESUMO

BACKGROUND: A large number of studies have shown that proton pump inhibitors (PPIs) are associated with infection events. Therefore, we retrospectively evaluated the association of PPI therapy with the occurrence of first pneumonia and peritoneal dialysis(PD)-related peritonitis events in the maintenance PD patients. METHODS: We collected PD patients in two large hospitals from January 1, 2012 to December 31, 2016, and divided them into the PPI group and the non-PPI group. Multivariate Cox proportional hazards models were applied to evaluate the cumulative incidence and hazard ratios (HRs). Inverse probability of treatment weight (IPTW) method was used to adjust for covariate imbalance between the two groups and further confirm our findings. RESULTS: Finally, 656 PD patients were included for data analysis, and the results showed that PPI usage was associated with an increased risk of pneumonia [HR 1.71; 95% CI 1.06-2.76; p = 0.027] and peritonitis [HR 1.73; 95% CI 1.24-2.40; p = 0.001]. IPTW-adjusted HRs for the association of PPIs with pneumonia and peritonitis were 1.58 (95% CI:1.18-2.12; p = 0.002) and 2.33 (95% CI:1.91-2.85; p < 0.001), respectively. Moreover, the competitive risk model proved that under the conditions of competition for other events(including transfer to hemodialysis therapy, kidney transplant, transfer from our research center, loss to follow-up, and death), the differences in endpoints events between the two groups were still statistically significant (p = 0.009, p < 0.001, respectively). CONCLUSIONS: PPIs was associated with an increased risk of first pneumonia and PD-related peritonitis events in PD patients, which reminds clinicians to be cautious when prescribing acid-suppressing drugs for PD patients.


Assuntos
Falência Renal Crônica , Diálise Peritoneal , Peritonite , Pneumonia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Peritonite/epidemiologia , Peritonite/etiologia , Pneumonia/epidemiologia , Pneumonia/etiologia , Modelos de Riscos Proporcionais , Inibidores da Bomba de Prótons/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
5.
Khirurgiia (Mosk) ; (10): 5-14, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36223144

RESUMO

OBJECTIVE: To analyze the causes of mortality in patients with acute appendicitis in Russia. MATERIAL AND METHODS: We retrospectively studied mortality in patients with acute appendicitis in the Russian Federation in 2020. We surveyed the hospitals with mortality reported in the electronic database of annual reports to the chief surgeon of the Ministry of Health of the Russian Federation. RESULTS: There were 259 deaths among 150.393 patients with acute appendicitis aged ≥18 years (in-hospital mortality 0.17%). We obtained data about 95.8% (n=248) of lethal cases including 86.3% (n=214) complicated and 13.7% (n=34) uncomplicated forms of disease. Two patients died without surgery (0.8%). Among the deceased, 58.2% (n=145) were men and 41.8% (n=103) were women. Mean patient age was 66.2 years [0.95% CI 64.2-68.1]. The main cause of death in complicated appendicitis was late presentation (after 4.9 days [0.95% CI 4.3-5.4]) that resulted peritonitis and sepsis in 71.5% (n=153) of patients. Cardiovascular diseases were noted in 23.4% (n=50) of cases. A new coronavirus infection was detected in 7.0% (n=15) of patients. However, COVID-19 as a direct cause of death was recognized in 2.8% (n=6) of cases. Other reasons accounted for 2.3% (n=5). In uncomplicated appendicitis, cardiovascular diseases were the main cause of mortality (73.5%, n=25). Peritonitis and sepsis were found in 11.8% (n=4) of cases, COVID-19 - in 5.9% (n=2). Other causes accounted for 8.8% (n=3). Diagnostic, tactical, technical problems and their combination were revealed in 54.4% of lethal outcomes. CONCLUSION: Mortality from acute appendicitis in the Russian Federation is low, comparable with international data, and mainly associated with delayed treatment and complicated course of disease. However, the impact of diagnostic, tactical and technical errors on the outcome of acute appendicitis is significant.


Assuntos
Apendicite , COVID-19 , Doenças Cardiovasculares , Laparoscopia , Peritonite , Sepse , Doença Aguda , Adolescente , Adulto , Idoso , Apendicectomia/métodos , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , Doenças Cardiovasculares/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Peritonite/etiologia , Estudos Retrospectivos , Sepse/cirurgia
8.
Nephrol Ther ; 18(6): 526-533, 2022 Nov.
Artigo em Francês | MEDLINE | ID: mdl-36241606

RESUMO

BACKGROUND: Peritonitis is a common complication of chronic peritoneal dialysis treatment contributing to both technique failure and/or death. Little is effectively known about the actual benefits of a continuous training program on peritonitis rates. In the present study, we measured the impact of our patients' training protocol on peritonitis rates. We further studied which consequences the COVID-related disruption of our follow-up program had on peritonitis rates. METHODS: We present our yearly peritonitis rates since our patients' training and retraining program was implemented in 2010. We then focused our study on three consecutive years: 2019, 2020 (emergence of COVID-19), and 2021, collecting microbiological data from each peritonitis episode. Statistical analysis were used to corroborate our findings. RESULTS: Since 2010, peritonitis rates declined linearly (R2=0,6556; df=8; P<0.01) until its nadir in 2019 with 4 peritonitis episodes. The majority of infections were then treated in the outpatient Clinic. In 2020, our continuous technique evaluation decreased by 51% and 28 peritonitis episodes occurred, 47% secondary to strict cutaneous bacteria's, and 31% gastro-intestinal, irrespective of patients' experience or peritoneal dialysis modality. The hospitalization rate reached 71%. Having restored our protocol, we decreased peritonitis rates by 50% in 2021. CONCLUSIONS: Risk factors for peritonitis are identifiable and modifiable and require sustained intervention, continuous visual monitoring and training. These interventions significantly reduce peritonitis rates. Any brief interruption to patients' technique evaluation may elevate peritonitis rates significantly.


Assuntos
COVID-19 , Diálise Peritoneal , Peritonite , Humanos , COVID-19/epidemiologia , Pandemias , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Peritonite/etiologia , Peritonite/microbiologia , Fatores de Risco
10.
Tunis Med ; 100(6): 481-484, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36206068

RESUMO

Peritonitis is an important cause of morbidity and technique failure in peritoneal dialysis. Herein, we report peritonitis related to Acinetobacter lwoffi in two patients on peritoneal dialysis. The first case is a 63-year-old patient treated by automated peritoneal dialysis admitted with abdominal pain. The peritoneal effluent White Blood Cells count consisted of 280 cells/mm3. Then culture identified a multisensitive Acinetobacter lwoffi. Treatment with ceftazidime and ciprofloxacin had been started. The control dialysate culture was sterile after three weeks. The second patient is a 59-year-old female admitted because of diffuse abdominal pain and cloudy dialysate. The peritoneal effluent White Blood Cells count consisted of countless leukocytes, with predominantly polynuclear and culture identified Acinetobacter lwoffi. He received intraperitoneal ceftazidim and amikacin for three weeks. The control dialysate was sterile. Acinetobacter lwoffi is a rare cause of peritonitis and it can be treated successfully with early recognition and appropriate antibiotic therapy based on culture instead of catheter removal.


Assuntos
Acinetobacter , Diálise Peritoneal , Peritonite , Dor Abdominal , Amicacina , Antibacterianos/uso terapêutico , Ceftazidima , Ciprofloxacina , Soluções para Diálise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Peritonite/diagnóstico , Peritonite/tratamento farmacológico , Peritonite/etiologia
12.
Ren Fail ; 44(1): 1791-1800, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36278836

RESUMO

BACKGROUND: The impact of p-cresyl sulfate (PCS) and indoxyl sulfate (IS) on the prognosis of patients with uremia remains controversial. We performed a prospective study on peritoneal dialysis (PD) to investigate the relationship between PCS or IS levels with clinical outcomes. METHODS: This prospective cohort study investigated the association of serum PCS and IS with clinical outcomes in patients undertaking PD. We performed a correlations analysis to explore the influencing factors of PCS an IS. Meta-analysis was conducted to objectively evaluate the prognostic effects of PCS and IS on different stages of CKD patients. RESULTS: A total of 127 patients were enrolled consecutively and followed with an average period of 51.3 months. Multivariate Cox regression showed that serum total PCS not only contributed to the occurrence of PD failure event (HR: 1.05, 95% CI = 1.02 to 1.07, p < 0.001), but also increased the risk of cardiovascular event (HR: 1.08, 95% CI = 1.04 to 1.13, p < 0.001) and PD-associated peritonitis (HR: 1.04, 95% CI = 1.02 to 1.08, p = 0.001). Dividing the total PCS level by 18.99 mg/L, which was calculated from the best cutoff value of the ROC curve, patients with total PCS higher than 18.99 mg/L had worse prognosis. Meta-analysis confirmed its value in cardiovascular event in PD. CONCLUSION: The serum total PCS concentration was a detrimental factor for higher PD failure event, cardiovascular event, and PD-associated peritonitis. It could be used as an innovative marker in predicting poor clinical outcome in PD.


Assuntos
Doenças Cardiovasculares , Falência Renal Crônica , Diálise Peritoneal , Peritonite , Humanos , Indicã , Ésteres do Ácido Sulfúrico , Seguimentos , Cresóis , Estudos Prospectivos , Sulfatos , Diálise Peritoneal/efeitos adversos , Estudos de Coortes , Peritonite/epidemiologia , Peritonite/etiologia
14.
Ren Fail ; 44(1): 1558-1567, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36154556

RESUMO

OBJECTIVE: To predict the risk factors for cardiovascular events within 5 years in patients with peritoneal dialysis-associated peritonitis and establish a nomogram for clinical prediction. METHODS: A prediction model was established by conducting an observational study in 150 patients with peritoneal dialysis-associated peritonitis obtained from the Information Database of AnHui Medical University Affiliated Hospital. The nomogram was constructed using the multivariate COX regression model. The C-index and the calibration plot were used to assess the discrimination and calibration of the prediction model. RESULTS: The elderly [HR = 2.453 (1.071-5.619)], history of cardiovascular events [HR = 2.296 (1.220-4.321)], alkaline phosphatase [HR = 1.004 (1.002-1.005)] and culture-positive [HR= 2.173 (1.009-4.682)] were identified as risk predictors of cardiovascular events, while serum albumin [HR = 0.396(0.170-0.924)] was identified as protective predictors of cardiovascular events. Combined with clinical studies, we constructed a nomogram based on the minimum value of the Akaike Information Criterion or Bayesian Information Criterion. The C index of the nomogram is 0.732, revealing great discrimination and appropriate calibration. Through the total score of the nomogram and the result of ROC, we classify patients into high-risk groups (cardiovascular events group) and low-risk groups (no cardiovascular events group). Cardiovascular events were significantly different for patients in the high-risk group compared to the low-risk group (HR = 3.862(2.202-6.772; p < 0.001). CONCLUSIONS: The current novel nomogram can accurately predict cardiovascular events in patients with peritonitis associated with peritoneal dialysis. However, external validation is required before the model can be used in clinic settings.


Assuntos
Diálise Peritoneal , Peritonite , Idoso , Fosfatase Alcalina , Teorema de Bayes , Humanos , Nomogramas , Diálise Peritoneal/efeitos adversos , Peritonite/diagnóstico , Peritonite/epidemiologia , Peritonite/etiologia , Estudos Retrospectivos , Albumina Sérica
15.
Ulus Travma Acil Cerrahi Derg ; 28(10): 1397-1403, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36169463

RESUMO

BACKGROUND: Surgical site infection continues to be a major problem after laparotomy for perforation peritonitis, as it increases morbidity and hospital stay and decreases the quality of life. Intra-abdominal drain placement is a routine practice in perforation peri-tonitis. The aim of our study is to compare the incidence of surgical site infection in two groups of patients who were operated for perforation peritonitis: The first group received the intraperitoneal drain, while no drain was placed in the second group. METHODS: The present single-center, prospective, non-randomized study was conducted in the Department of General Surgery at the Postgraduate Institute of Medical Education and Research, India. A total of 122 patients underwent exploratory laparotomy for gastroduodenal and small bowel perforation peritonitis, of which 100 participants were included in this study, based on specified cri-teria for inclusion and exclusion. A total of 50 participants each were included in the drain group and the no drain group, respectively. A drain was placed in every alternate patient with perforation peritonitis who received primary closure or resection anastomosis. Patients with diabetes, renal failure, and hemodynamic instability and those who presented more than 72 h since symptom onset were excluded from the study. Peritoneal fluids were cultured. The primary endpoint was to identify the incidence of surgical site infections (SSIs) in the two groups. We also compared the time taken for the return of bowel movements, duration for which a nasogastric tube was inserted, whether any intervention was performed under local or general anesthesia within 30 days of surgery, the duration of hospital stay, and the ease of diagnosing repair leak in the post-operative period in both the groups. RESULTS: Demographics of participants in both the groups were matched. No significant difference was observed between the drain and no-drain groups with respect to the incidence of surgical site infection (p=0.779). The duration of surgery and length of hospital stay were significantly lower in the no drain group. A significant difference was observed between the two groups concerning the peritoneal culture growth, and increased bacterial growth was seen in the drain group. No significant difference in morbidity was noted between the two groups, which was classified according to the Clavien-Dindo classification. CONCLUSION: Routine use of intra-abdominal drains was not found to be effective in preventing SSIs, but a selection bias cannot be ruled out. Patients with no drains had a significantly shorter duration of hospital stay.


Assuntos
Peritonite , Infecção da Ferida Cirúrgica , Drenagem/efeitos adversos , Humanos , Peritonite/epidemiologia , Peritonite/etiologia , Peritonite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Qualidade de Vida
16.
Biomed Res Int ; 2022: 2733659, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36172488

RESUMO

Objective: To summarize the advantages of peritoneal dialysis (PD) catheters without capsular puncture (only one pneumoperitoneum needle) puncture technique conducted by our center. Methods: The study examines the clinical data of PD patients (including the general situation of patients, intraoperative and postoperative characteristics, and complications) undergoing pneumoperitoneum needle catheterization from January 2019 to May 2021 in the Department of Nephrology at the First Affiliated Hospital of Hebei North University (the largest peritoneal dialysis center in Zhangjiakou). Results: A total of 153 surgical cases were collected. There were 91 males and 62 females. The mean (± standard deviation) age was 56.1 ± 18.6 years, and the mean (± standard deviation) follow-up time was 16.7 ± 8.2 months. The average operation time was 30.33 minutes with a standard deviation of 14.80 minutes. The length of abdominal incision is 2.38 ± 0.42 cm, and the blood loss was about 26.3 ± 9.2 ml, including 2 cases of laparoscopic reposition of drift tube, 0 case of pipe blockage, 3 cases of fluid leakage, 1 case of peritoneal dialysis catheter tunnel infection, 4 cases of outlet infection, 12 occurrences of peritonitis, 121.3 patient months in peritonitis, and 0 times in omentum wrapping without bladder injury, incisional hernia, or intestinal injury. Conclusion: Relative to open operation, the peritoneal dialysis (PD) catheters with pneumoperitoneum needle puncture technique has the following advantages: simpler operation, shorter operation time, less bleeding, less injury, less complications, and higher safety. Moreover, there are no additional costs compared with open operation. Thus, the technique is recommended for clinical applications.


Assuntos
Laparoscopia , Diálise Peritoneal , Peritonite , Pneumoperitônio , Adulto , Idoso , Cateterismo/métodos , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Pneumoperitônio/complicações , Punções/efeitos adversos , Estudos Retrospectivos
17.
Hinyokika Kiyo ; 68(8): 271-275, 2022 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-36071019

RESUMO

A 74-year-old patient was undergoing treatment for ascending colon cancer (cT4aN2M1a) in the Department of Surgery at our hospital. During treatment for increased lymph node metastasis and spinal metastasis, she complained of numbness in her dorsal thigh. Magnetic resonance imaging showed spinal canal stenosis due to L4 bone metastasis. Immediately after starting radiation therapy for L4 bone metastasis, bladder rupture occurred and led to generalized peritonitis. We performed emergency laparotomy and drainage. Later, the patient's general condition improved, but irreversible neurological symptoms remained, and activities of daily living decreased markedly. This was thought to be caused by weakening of the bladder wall due to chronic cystitis, and hyperextension of the bladder due to neurogenic bladder. Bacteriuria leaked into the abdominal cavity, resulting in generalized peritonitis.


Assuntos
Neoplasias Colorretais , Cistite , Peritonite , Neoplasias da Coluna Vertebral , Atividades Cotidianas , Idoso , Neoplasias Colorretais/complicações , Cistite/complicações , Feminino , Humanos , Peritonite/diagnóstico , Peritonite/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Bexiga Urinária
18.
G Ital Nefrol ; 39(4)2022 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-36073334

RESUMO

Conceived and developed since 2001 at the Alba Center, Videodialysis (VD) was used initially to prevent dropout in prevalent PD patients by guiding them in performing dialysis (VD-Caregiver). Subsequently, its use was extended to the clinical follow-up of critical patients (VD-Clinical), problems relating to transport to the Center (VD-Transport), and since 2016 for training/retraining all patients (VD-Training). Since 2017 other Centers have employed VD using modalities analyzed in this paper. Methods: the paper reports the findings of an Audit (February 2021) of the Centers using VD on 31-12-2020. The Centers provided the following information: the characteristics of the patients using VD; the main and secondary reasons for using VD, considering nursing home (VD-NH) patients separately; VD outcomes: duration, drop-out, peritonitis, patient/caregiver satisfaction (minimum: 1 - maximum: 10). Results: VD, which began between 09-2017 and 12-2019, has been used in 6 Centers for 54 patients at 31-12-2020 (age:71.8±12.6 years - M:53.7% - CAPD:61.1% - Assisted PD:70.3%). The most frequent reason has been VD-Training (70.4%), followed by VD-Caregiver (16.7%), VD-NH (7.4%), VD-Clinical (3.7%), and VD-Transport (1.9%), with differences between Centers. VD-Training is used most with self-care patients (93.8% - p<0.05), while with patients on Assisted PD it is associated with secondary reasons (95.7% - p<0.02). VD-Training (duration: 1-4 weeks) has always been completed successfully. No peritonitis was reported; satisfaction was 8.4±1.4. Conclusion: videodialysis is a flexible, effective, safe, and valued tool that can be employed using various modalities depending on the choice of the Center and the complexity of the patient.


Assuntos
Diálise Peritoneal , Peritonite , Idoso , Idoso de 80 Anos ou mais , Humanos , Itália , Pessoa de Meia-Idade , Peritonite/epidemiologia , Peritonite/etiologia , Diálise Renal
19.
R I Med J (2013) ; 105(8): 47-49, 2022 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-36173909

RESUMO

For the 11% of dialysis patients worldwide who receive peritoneal dialysis (PD) to treat their end-stage kidney disease (ESKD), recent PD-associated peritonitis is estimated to contribute to 5-30% of reported mortality.1,2 These infections are most commonly caused by coagulase-negative Staphylococcus (32%), followed by culture-negative peritonitis (16%), and the timely identification and targeted treatment of peritonitis is critical to avoid complications such as PD catheter removal.3 Here, we present a case of atypical Rothia mucilaginosis peritonitis in a PD patient.


Assuntos
Diálise Peritoneal , Peritonite , Coagulase , Humanos , Micrococcaceae , Diálise Peritoneal/efeitos adversos , Peritonite/tratamento farmacológico , Peritonite/etiologia , Diálise Renal
20.
Rev Fac Cien Med Univ Nac Cordoba ; 79(3): 280-284, 2022 09 16.
Artigo em Espanhol | MEDLINE | ID: mdl-36149071

RESUMO

Introduction: Streptococcus pneumoniae (Spn) is occasionally implicated as a cause of intra-abdominal infection (IIASpn) that can be 1) spontaneous bacterial peritonitis (SBP) in elderly patients with previous peritoneal disease, associated with cirrhosis, in most of the cases 2) associated or adjacent to an intra-abdominal organ or postsurgical. (IIAbq) 3) peritonitis in previously healthy young women (PHYW). Our objective is report 18 cases of IIASpn describing: clinical presentation, comorbidities, need for surgery, microbiological findings, sensitivity of Spn to antimicrobials, therapeutic behavior, and evolution. Methods: study of 18 adult patients with IIASpn. Clinical and microbiological characteristics and evolution of infections were analyzed. Results: IIASpn occurred in 9 PHYW, 6 men and 1 woman with SBP, and 2 men with appendicitis. The PHYW were operated on (4 pelviperitonitis, 3 salpingitis, 2 and tubo ovarian abscess) and had a favorable evolution. In the intraoperative samples, pure culture of Spn sensitive to penicillin was isolated. Three of four patients had positive blood culture. Five of seven patients with SBP died and in the peritoneal fluid developed Spn in pure culture. A large percentage of strains presented decreased sensitivity to penicillin. Four of five had a positive blood culture. Patients with appendicitis had favorable evolution. Conclusions: IIASpn in PHYW was the most frequent presentation, surgery played a significant role in treatment and the clinical response was excellent. The second presentation occurred in elderly patients with cirrhosis, most of whom died. Appendicitis was the third presentation in patients who evolved favorably.


Introducción: Streptococcus pneumoniae (Spn) ocasionalmente causa infección intraabdominal (IIASpn) que puede ser: 1) peritonitis bacteriana espontánea (PBE) en paciente añosos con enfermedad peritoneal previa, asociada con cirrosis, en la mayoría de los casos; 2) asociada o adyacente a un órgano intraabdominal o postquirúrgica (IIAbq); 3) peritonitis en mujeres jóvenes previamente sanas (MJPS). Nuestro objetivo es reportar 18 casos de IIASpn describiendo: presentación clínica, comorbilidades, necesidad de cirugía, microbiología y sensibilidad a los antimicrobianos, conducta terapéutica y evolución. Métodos: estudio de 18 pacientes adultos con IIASpn en un período de 23 años. Análisis de las características clínicas, microbiología y evolución de los pacientes. Resultados: las IIASpn ocurrieron en 9 MJPS, 6 varones y una mujer con PBE, y 2 varones con apendicitis. Las MJPS fueron intervenidas quirúrgicamente (4 pelviperitonitis, 3 salpingitis y 2 abscesos tubo ovárico) y evolucionaron favorablemente. En las muestras intraoperatorias se aisló Spn cultivo puro sensible a penicilina. Tres de cuatro pacientes tuvieron hemocultivo positivo. Cinco de siete pacientes con PBE fallecieron y en las muestras de líquido peritoneal desarrolló Spn cultivo puro. Gran porcentaje de cepas presentó sensibilidad disminuida a penicilina. Cuatro de cinco, tuvieron hemocultivo positivo. Los pacientes con apendicitis evolucionaron favorablemente. Conclusiones: La IIASpn en MJPS fue la presentación más frecuente, la cirugía jugó un rol significativo en el tratamiento y la respuesta clínica fue excelente. La segunda presentación ocurrió en pacientes añosos con cirrosis y en su mayoría, fallecieron. La apendicitis fue la tercera presentación en pacientes que evolucionaron favorablemente.


Assuntos
Apendicite , Infecções Intra-Abdominais , Peritonite , Adulto , Idoso , Antibacterianos/uso terapêutico , Apendicite/complicações , Apendicite/cirurgia , Feminino , Humanos , Infecções Intra-Abdominais/complicações , Infecções Intra-Abdominais/tratamento farmacológico , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Masculino , Penicilinas , Peritonite/etiologia , Peritonite/microbiologia , Streptococcus pneumoniae
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