RESUMO

INTRODUCCIÓN: El uso de un esquema antibiótico inadecuado en sepsis aumenta significativamente la morbimortalidad. Este estudio presenta un reporte multicéntrico de susceptibilidad antibiótica en urosepsis asociada a ureterolitiasis, buscando proponer un esquema empírico óptimo para el medio nacional. MÉTODOS: Se realizó un estudio observacional prospectivo en 7 hospitales de 4 regiones del país. Se incluyeron pacientes con criterios de sepsis asociada a ureterolitiasis confirmada radiológicamente. Se registraron sus datos demográficos, signos vitales y laboratorio de ingreso, así como sus estudios microbiológicos y radiológicos, realizándose estadísticas descriptivas de los datos obtenidos. RESULTADOS: Se ingresaron 119 pacientes, de los cuales 52 cumplieron criterios de inclusión. 77% eran mujeres, con una edad promedio de 52 años. Se tomaron hemocultivos en el 48,7% de los casos y urocultivos en el 100%. El microorganismo más común fue Escherichia coli (73%), seguido por Proteus mirabilis (9,6%) y Klebsiella pneumoniae (3,9%). Hubo dos casos de bacterias gram positivas. El 100% de las bacterias gram negativas fueron sensibles a amikacina. CONCLUSIÓN: Los microorganismos encontrados en nuestra cohorte fueron similares a los de los estudios internacionales. Dado que el mayor nivel de susceptibilidad fue para amikacina, proponemos su uso como terapia empírica para la urosepsis asociada a ureterolitiasis en Chile. Siempre es necesario considerar los posibles efectos ne-frotóxicos de la amikacina. Se debe considerar una asociación de betalactámicos y glicopéptidos en pacientes con factores de riesgo de infecciones enterocócicas.

BACKGROUND: Inadequate antibiotic coverage in septic patients is associated with higher morbidity and mortality. This multicentric study reports antibiotic susceptibility in patients with ureterolithiasis-associated urosepsis, aiming to propose an optimal empirical therapy for this disease in the Chilean population. METHODS: The prospective cohort study included patients from 7 Chilean hospitals who presented with ureterolithiasis and met sepsis criteria. We analyzed demographic data, vital signs at admission, and microbiological and radiological exams. We used descriptive statistics for the analysis of collected data. Results: Initially, the study included 119 patients; 52 met the inclusion criteria. 77% were female, with a mean age of 52. 100% of the cohort had a urine culture taken at admission, whereas 48,7% had blood cultures. Escherichia Coli was the most common microorganism (73%), followed by Proteus Mirabilis (9.6%) and Klebsiella Pneumoniae (3.9%). Only two patients presented gram-positive pathogens. 100% of gram-negative bacteria were sensible to amikacin. CONCLUSION: The microorganisms found in our cohort were similar to those in international reports. Since the highest level of susceptibility was for amikacin, we propose its use as empirical therapy for urosepsis associated with ureterolithiasis in Chile. It is always necessary to consider the potential nephrotoxic effects of amikacin. An association of beta-lactams and glycopeptides should be considered in patients with risk factors for enterococcal infections.

Assuntos

RESUMO

BACKGROUND: Inadequate antibiotic coverage in septic patients is associated with higher morbidity and mortality. This multicentric study reports antibiotic susceptibility in patients with ureterolithiasis-associated urosepsis, aiming to propose an optimal empirical therapy for this disease in the Chilean population. METHODS: The prospective cohort study included patients from 7 Chilean hospitals who presented with ureterolithiasis and met sepsis criteria. We analyzed demographic data, vital signs at admission, and microbiological and radiological exams. We used descriptive statistics for the analysis of collected data. RESULTS: Initially, the study included 119 patients; 52 met the inclusion criteria. 77% were female, with a mean age of 52. 100% of the cohort had a urine culture taken at admission, whereas 48,7% had blood cultures. Escherichia Coli was the most common microorganism (73%), followed by Proteus Mirabilis (9.6%) and Klebsiella Pneumoniae (3.9%). Only two patients presented gram-positive pathogens. 100% of gram-negative bacteria were sensible to amikacin. CONCLUSION: The microorganisms found in our cohort were similar to those in international reports. Since the highest level of susceptibility was for amikacin, we propose its use as empirical therapy for urosepsis associated with ureterolithiasis in Chile. It is always necessary to consider the potential nephrotoxic effects of amikacin. An association of beta-lactams and glycopeptides should be considered in patients with risk factors for enterococcal infections.

Assuntos

Assuntos

RESUMO

Se presenta el caso clínico de una paciente de 30 años, con diagnóstico de VIH + desde el año 2000, en terapia antirretroviral desde el año 2004. Desde el año 2007 con disnea de esfuerzo progresiva, que en el último año se hace severa, asociada a astenia, fatigabilidad y edema vespertino de extremidades inferiores. El ecocardiograma detecta un aumento de la presión de arteria pulmonar, lo que se confirma a través de un cateterismo cardíaco derecho. Se descarta tromboembolismo pulmonar y se concluye como una HAP secundaria a VIH. La hipertensión arterial pulmonar (HAP) es una enfermedad de baja frecuencia y se puede asociar a infección por virus de la inmunodeficiencia humana (VIH), presentando una prevalencia 6 a 12 veces mayor en relación a individuos sin infección por VIH. La HAP es independiente del recuento de linfocitos T CD4 y en su patogenia participan proteínas virales, como la glicoproteína 120 y las proteínas Nef y Tat, que estimulan una cascada inflamatoria sistémica, induciendo angiogénesis en los vasos pulmonares. El estudio hemodinámico a través de cateterismo derecho es el método de elección para la confirmación diagnóstica.

We report the case of a patient 30 years, diagnosed with human immunodeficiency virus (HIV) since 2000, on antiretroviral therapy since 2004. Since 2007 with progressive dyspnea, which in the past year becomes severe, associated with asthenia, fatigue and edema of lower limbs evening. Echocardiography detects an increase in pulmonary artery pressure, which is confirmed by a right heart catheterization. Pulmonary embolism is ruled out and concludes as a pulmonary arterial hypertension (PAH) secondary to HIV. Pulmonary arterial hypertension is a disease of low frequency and can be associated with infection by HIV, with prevalence 6 to 12 times greater relative to individuals without HIV infection. PAH is independent of CD4 T lymphocyte count and viral proteins involved pathogenesis, such as glycoprotein 120 and Nef and Tat proteins, which stimulate a systemic inflammatory cascade, inducing angiogenesis in the pulmonary vessels. The hemodynamic study through right heart catheteri-zation is the method of choice for diagnostic confirmation.

Assuntos