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Significance: The laparotomy is a common surgical procedure with a wide range of indications. Ideally, once the goals of surgery were achieved, the incision edges could then be approximated and the abdomen primarily closed. However, in some circumstances, it may be impossible to achieve primary closure, and instead the abdomen is intentionally left open. This review discusses the indications and objectives for the open abdomen (OA), summarizes the most common techniques for temporary abdominal closure, and illustrates treatment algorithms grounded in the current recommendations from specialty experts. Recent Advances: Still a relatively young technique, multiple strategies, and technologies have emerged to manage the OA. So too have the recommendations evolved, based on updated classifications that take wound characteristics into account. Recent studies have also brought greater clarity on recommendations for managing infection and malnutrition to support improved clinical outcomes. Critical Issues: The status of the OA can change rapidly depending on the patient's condition, the wound quality, and many other factors. Thus, there is a significant need for comprehensive treatment strategies that can be adapted to these developing circumstances. Future Directions: Treatment recommendations should be continuously updated as new technologies are introduced and old techniques fall out of use.

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A one-year-old female miniature goat was presented to an emergency service after calving a dead goatling. Physical and ultrasonographic examination revealed the presence of a viable fetus; therefore, the goat was submitted to an emergency cesarean section. In the postoperative period, the animal had septic peritonitis caused by Enterococcus faecium and Enterococcus casseliflavus. Both bacterial strains showed contrasting antimicrobial resistance profiles. Laparohysterectomy and abdominal cavity lavage were performed, but, once the animal had adhesions and necrotic lesions in abdominal organs, euthanasia was executed. A post-mortem examination revealed fibrino-necrotic septic peritonitis secondary to uterine rupture. To the authors' knowledge, this is the first detailed report of polymicrobial septic peritonitis in a miniature goat and the first report of septic peritonitis caused by E. faecium and E. casseliflavus.

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A rare condition, sclerosing encapsulating peritonitis, is characterized by a fibrotic membrane forming over the bowels, leading to intestinal obstruction. In this case of a 56-year-old male patient with a history of laparoscopic gastric bypass, a computed tomography scan showed findings indicative of the condition. Extensive adhesiolysis was performed, and biopsies confirmed the presence of fusiform cells (D2-40 positive on immunochemistry) resembling fibroblasts, within dense collagenous peritoneal tissue sheets, typical of sclerosing encapsulating peritonitis. The prevalence of this condition is uncertain, and diagnosis typically requires a peritoneal biopsy due to the nonspecific clinical presentation.

La peritonitis esclerosante encapsulada es una condición rara caracterizada por una membrana fibrótica que se genera sobre las asas intestinales causando cuadros de oclusión intestinal. Se presenta el caso de un paciente varón de 56 años con antecedente de derivación gastroyeyunal por laparoscopia que presenta oclusión intestinal. Se realizó tomografía computada que evidenció sitio de transición previo al sitio de anastomosis. Se realizó de anastomosis extensa y toma de biopsias. Histológicamente se observó engrosamiento de la membrana peritoneal, células fusiformes (D2-40 positivo en inmunohistoquímica) similares a fibroblastos con láminas de colágeno peritoneal denso. La peritonitis esclerosante encapsulada es una patología de prevalencia desconocida. El cuadro clínico es inespecífico y el diagnóstico definitivo es por patología con biopsia peritoneal.

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Antibiotic prophylaxis in patients with cirrhosis and acute variceal bleeding is part of the standard of care according to most clinical guidelines. However, with recent evidence arguing against antibiotic prophylaxis, the role of this intervention has become less clear.

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SUMMARY: Experimental studies devoted to the study of the mechanisms of the pathogenesis of acute peritonitis and the development of new methods of medical and surgical treatment are becoming increasingly relevant. Today, experimental medicine knows many different ways to modeling septic peritonitis and eliminate it, but the role of the local immune system is underestimated, whereas it takes a direct part in inflammation. The objective of our work to study morphological features of results of experimental modeling of septic peritonitis in white rats. The study included 15 sexually mature white male rats weighing 276.75±6.56 grams. A simulation of septic peritonitis was performed by perforating the upper part of the cecum with four punctures with a G16 injection needle. As a result of the experiment, after examination of the peritoneal cavity, all 15 animals were diagnosed with omentum tamponade of perforated damage to the caecum. In 11 cases, the perforated wall of the caecum was covered by the greater omentum (73.34 %), and in the other 4 animals, tamponade was performed by one of the epididymal omentum (26.66 %). The initial stage of tamponade with the greater or epididymal omentums of a perforated caecum begins on the first day of the experiment and consists of tight interstitial consolidation between them, as well as in the invasion of blood vessels from the omentum side to the focus of infection, which ensure the delivery of the appropriate immunocompetent cells. As a result of this process, intensive lymphoid infiltrates are formed in this area, as well as the growth of adipose tissue, which isolates the inflammatory focus from the peritoneal cavity with a thick layer.

Las investigaciones experimentales dedicadas al estudio de los mecanismos de patogénesis de la peritonitis aguda y el desarrollo de nuevos métodos de tratamiento médico y quirúrgico son cada vez más relevantes. Hoy en día, la medicina experimental conoce muchas formas diferentes de modelar la peritonitis séptica y eliminarla, pero se subestima el papel del sistema inmunológico local, mientras que él participa directamente en la inflamación. El objetivo de nuestro trabajo fue estudiar las características morfológicas de los resultados del modelado experimental de peritonitis séptica en ratas blancas. El estudio incluyó 15 ratas macho blancas, sexualmente maduras que pesaban 276,75 ± 6,56 gramos. Se realizó una simulación de peritonitis séptica perforando la parte superior del ciego con cuatro punciones con una aguja de inyección G16. Como resultado del experimento, después del examen de la cavidad peritoneal, a los 15 animales se les diagnosticó taponamiento del omento o lesión perforada del ciego. En 11 casos, la pared perforada del ciego fue recubierta por el omento mayor (73,34 %), y en los otros 4 animales el taponamiento se realizó por uno de los epidídimos (26,66 %). La etapa inicial del taponamiento con omento mayor o epidídimo de un ciego perforado comienza el primer día del experimento y consiste en una estrecha consolidación intersticial entre ellos, así como en la invasión de los vasos sanguíneos desde el lado del omento hasta el foco de infección, que aseguran la entrega de las células inmunocompetentes apropiadas. Como resultado de este proceso, se forman intensos infiltrados linfoides en esta zona, así como el crecimiento de tejido adiposo, que aísla el foco inflamatorio de la cavidad peritoneal con una gruesa capa.

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Resumen La peritonitis por neumococo comprende un pequeno subconjunto de pacientes con enfermedad invasiva (ENI). Durante 15 años (2005-2020) de vigilancia de ENI en un hospital de pediatría, se detectaron 5 casos de peritonitis primaria. Los pacientes, 3 ninas y 2ninos con una media de edad de 5 anos, experimentaron signos y síntomas peritoneales; 3 de ellos presentaban síndrome nefrótico. En coincidencia con los perfiles locales, todos los aislamientos fueron sensibles a betalactámicos, una cepa expresó resistencia a tetraciclina y cotrimoxazol y otra solo a cotrimoxazol. Los serotipos encontrados en 4/5 cepas (una resultó no viable) fueron 1, 19F, 15C y 23A. Los ninos fueron tratados con cefalosporinas de tercera generación o con ampicilina, gentamicina y metronidazol; todos evolucionaron favorablemente. Se destaca la importancia del hallazgo de Streptococcus pneumoniae en peritonitis primarias en niños. Este trabajo contribuye al conocimiento de esta enfermedad en particular y al de la epidemiología local de la ENI.

Abstract Pneumococcal peritonitis represents a small subset of patients suffering from inva-sive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

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BACKGROUND: The first year of dialysis is critical given the significant risk for complications following dialysis initiation. We analysed complications during the first year among incident peritoneal dialysis (PD) patients. METHODS: This retrospective cohort study comprised adult kidney failure patients starting PD in Baxter Renal Care Services in Colombia, receiving their first PD catheter between 1 January 2017 and 31 December 2020 and were followed up for up to 1 year. We analysed incidence, causes and factors associated with complications using logistic regression and transfer to haemodialysis (HD) using the Fine-Gray regression model. RESULTS: Among 4743 patients receiving their first PD catheter: 4628 (97.6%) of catheter implantations were successful; 377 (7.9%) patients experienced early complications. The incidence rate of complications during the year was 0.51 events per patient-year (95% CI: 0.48-0.54). Age, obesity and urgent start were associated with higher probability of complications after catheter implantation. The cumulative incidence of transfer to HD within 1 year of PD initiation was 10.1% [95% CI: 9.2-11.1%]. The hazard function for transfer to HD showed an accelerating pattern during the first month followed by progressive decrease during the first year. CONCLUSIONS: In this large population of incident PD patients, there is a high primary catheter placement success rate. Urgent start, age ≥65 years, obesity, centre size ≥150 PD patients and diabetes were risk factors associated with early complications. The follow-up of the cohort from day 1 of PD treatment showed that the risk for transfer to HD was higher during the first month.

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AIM: This study aimed to evaluate the expression levels of miR-99b and miR-135b in peritoneal carcinoma and liver metastases associated with Colorectal Cancer (CRC), assess their association with the intracellular signaling pathway proteins Kirsten Rat Sarcoma Virus (KRAS) and Akt, and investigate their effects on survival. MATERIALS AND METHODS: Changes in the KRAS gene and Akt proteins, expression levels of miR-99b and miR-135b, and factors affecting survival were compared between colorectal cancer-associated peritoneal carcinomatosis and liver metastasis. RESULTS: The expression levels of miR-99b and miR-135b and the immunohistochemical grade classification score of Akt were higher in colorectal cancer, peritoneal carcinomatosis, and liver metastasis than in normal tissues (p < 0.05). MiR-99b expression was highest in CRC, whereas miR-135b expression was highest in peritoneal carcinomatosis (p < 0.05). The expression level of miR-99b decreased and that of miR-135b increased in peritoneal and liver metastases compared with that in the tumor tissue. MiR-99b, Akt, and recurrence were risk factors that affected the overall survival rate in the model of clinical predictions (p = 0.045, p = 0.006, and p = 0.012, respectively). CONCLUSION: While the expression of miR-99b was highest in the primary tumor, its decrease in liver metastasis and peritoneal carcinomatosis suggests that miR-99b has a protective effect against liver metastasis and peritoneal carcinomatosis. However, the detection of miR-135b expression was highest in peritoneal carcinomatosis and liver metastasis compared with that in the colorectal cancer tissues suggesting that it facilitates peritoneal carcinomatosis and liver metastasis. Furthermore, miR-99b, KRAS mutations, and Akt are risk factors for the overall survival of colorectal cancer.

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La peritonitis asociada a diálisis peritoneal es una complicación grave en el paciente con este tipo de modalidad de terapia de reemplazo renal, siendo la etiología fúngica una de las que conlleva mayor morbimortalidad. Presentamos el caso de un paciente de 22 años que desarrolló una peritonitis asociada a diálisis peritoneal causada por el complejo Paecilomyces variotii; un hongo filamentoso poco frecuente en este grupo de pacientes.

Peritonitis associated with peritoneal dialysis is a serious complication in patients with this type of renal replacement therapy modality, with fungal aetiology being one of the most associated with morbidity and mortality. We present the case of a 22-year-old patient who developed fungal peritonitis associated with peritoneal dialysis caused by Paecilomyces variotii complex; a rare cause of peritonitis in this group of patients.

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Objetivo: Describir la morbimortalidad de los pacientes con diagnóstico de peritonitis apendicular, sometidos a cirugía laparoscópica en el Servicio de Cirugía General del Hospital Universitario de Caracas, durante el periodo enero 2013 - diciembre 2018. Métodos: estudio retrospectivo, descriptivo, observacional de corte transversal. Se revisaron las historias clínicas de los pacientes con peritonitis apendicular que fueron sometidos a cirugía laparoscópica en los servicios de Cirugía I, II, III y IV del Hospital Universitario de Caracas, en el período enero 2013-diciembre 2018. Las variables cuantitativas se expresaron en media ± desviación estándar y variables cualitativas en frecuencia y porcentaje; los datos se procesaron en el programa estadístico SPSS 19 (SPSS, inc., Chicago, EEUU). Resultados: la muestra estuvo conformado por 60 pacientes con edades entre 12 y 78 años, con el 78,33% en el grupo etario de 10 a 29 años; el sexo masculino representó el 58,33% de la muestra, con un promedio de edad de 23,90± 11,84 años; las complicaciones se presentaron en el 18,33% de los casos, más frecuente la infección del sitio operatorio con 6,67% (n=4) de los pacientes. La estancia hospitalaria global fue de 4,80 ± 2,58 días. Un paciente falleció. Conclusiones: el abordaje laparoscópico para el tratamiento de la peritonitis apendicular difusa se relaciona con muy baja morbimortalidad postoperatoria. La complicación más frecuente fue la infección del sitio operatorio. La mayoría de los pacientes solo ameritó una intervención quirúrgica(AU)

Objective: To describe the morbimortality ofpatients with a diagnosis of appendicular peritonitis undegoinglaparoscopic surgery in the General Surgery Department of the University Hospital of Caracas, during the period January2013 - December 2018. Methods: A retrospective, descriptive,observational, cross-sectional, descriptive study was performed.the medical records of patients with appendicular peritonitis who underwent laparoscopic surgery in the Surgery I, II, III and IV services of the University Hospital of Caracas were reviewed. Period January 2013-December 2018. Quantitative variables are expressed as mean ± standard deviation and qualitative variablesas frequency and percentage. The data were processed in the SPSS 19 statistical program (SPSS, inc., Chicago, USA). Results: the sample consisted of 60 patients aged between 12 and 78 years, with 78.33% in the age group 10 to 29 years. Male sex represented 58.33% of the sample, with an average age of 23.90 ±11.84 years. Complications occurred in 18.33% of the cases, with6.67% (n=4) of the patients reporting surgical site infection. The overall hospital stays of 4.80 ± 2.58 days. One patientdied. Conclusions: the laparoscopic approach is of choice for the treatment of diffuse appendicular peritonitis. The most frequent complication was surgical site infection. Most of the patients only required one surgical intervention(AU)

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This case involved a 2-year-old neutered male domestic mixed-breed cat that was rescued from the street eight months earlier. The animal presented with weakness, hyporexia, progressive weight loss, fatigue, uveitis, pale mucous membranes, dehydration (7%), and pelvic limb paresis. Aqueous humor was collected for molecular analysis for the differential diagnosis of potential etiological agents [Feline coronavirus (FCoV), Feline leukemia virus (FeLV), Feline immunodeficiency virus (FIV), Toxoplasma gondii, Cryptococcus spp., Felid herpesvirus-1 (FHV-1) and Bartonella spp.] of feline uveitis. The sample was positive by real-time reverse transcription-polymerase chain reaction (RT-qPCR) for FCoV and RT-qPCR and real-time polymerase chain reaction (qPCR) for FeLV and qPCR FIV. The cat was euthanized due to poor clinical outcomes and prognosis. A cerebrospinal fluid (CSF) sample was collected and tested, and the same pathogens were found in the aqueous humor. Small-cell follicular multicenter lymphoma and multifocal pyogranulomatous meningoencephalitis were observed upon histopathological analysis. In this study, aqueous humor and cerebrospinal fluid samples were efficient for the detection of coinfection with FIV, FeLV, and FCoV.

O caso refere-se a um gato de dois anos de idade, sem raça definida, resgatado da rua há oito meses. O animal apresentava fraqueza, hiporexia, emagrecimento progressivo, cansaço fácil, uveíte, mucosas pálidas, desidratação (7%) e paresia de membros pélvicos. O humor aquoso foi coletado para o diagnóstico molecular diferencial de potenciais agentes etiológicos [coronavírus felino (FCoV), vírus da leucemia felina (FeLV), vírus da imunodeficiência felina (FIV), Toxoplasma gondii, Cryptococcus spp., herpesvírus felino tipo 1 (FHV-1) and Bartonella spp.] causadores de uveíte felina. A amostra foi positiva na reação em cadeia da polimerase precedida por transcrição reversa em tempo real (RT-qPCR) para FCoV, RT-qPCR e reação em cadeia da polimerase em tempo real (qPCR) para FeLV e qPCR para FIV. O animal foi submetido à eutanásia - devido ao quadro clínico e prognóstico desfavorável. Amostra de líquido cefalorraquidiano (LCR) foi coletada e testada, confirmando a identificação dos mesmos patógenos encontrados no humor aquoso. Linfoma multicêntrico folicular de pequenas células e meningoencefalite piogranulomatosa multifocal foram observados na análise histopatológica. Neste relato, as amostras de humor aquoso e líquido cefalorraquidiano foram eficientes para a detecção de coinfecção por FIV, FeLV e FCoV.

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Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Forty-eight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM.

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Bertholletia excelsa is native to the Amazon Rainforest and is popularly known as the Brazil nut. It has socioeconomic importance due its nuts being a great export product. There are few studies in the literature regarding the biotechnological potential of its bark, although it is used in folk medicine. The aim of this study was to determine the chemical constituents, anti-inflammatory and antioxidant properties of B. excelsa bark extract (BEB). Twelve substances were identified by LC/MS/MS, and cytotoxicity tests were carried out, as well as analyses of nitric oxide production and elimination of free radicals. BEB caused cytoprotection against oxidative stress in macrophages, increased HMOX-1 expression, overcame the antioxidant effects of GPx-1 and reduced its expression and was able to inhibit leukocyte migration in use peritonitis. BEB efficiently attenuated oxidative stress due to its antioxidant and anti-inflammatory properties and, as such, can be used as a safe and effective source of a natural herbal medicine.

Bertholletia excelsa es originaria de la selva amazónica y se la conoce popularmente como nuez de Brasil. Tiene importancia socioeconómica debido a que sus frutos secos son un gran producto de exportación. Existen pocos estudios en la literatura sobre el potencial biotecnológico de su corteza, aunque se utiliza en medicina popular. El objetivo de este estudio fue determinar los componentes químicos, las propiedades antiinflamatorias y antioxidantes del extracto de corteza de B. excelsa (BEB). Se identificaron 12 sustancias mediante LC/MS/MS y se realizaron pruebas de citotoxicidad, así como análisis de producción de óxido nítrico y eliminación de radicales libres. BEB causó citoprotección contra el estrés oxidativo en macrófagos, aumentó la expresión de HMOX-1, superó los efectos antioxidantes de GPx-1 y redujo su expresión y fue capaz de inhibir la migración de leucocitos en la peritonitis de uso. BEB atenuó eficazmente el estrés oxidativo debido a sus propiedades antioxidantes y antiinflamatorias y, como tal, puede utilizarse como una fuente segura y eficaz de un medicamento a base de hierbas naturales.

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Resumen La definición de la enfermedad renal crónica (ERC) es la disminución del filtrado glomerular (FG) por debajo de 60 ml/min/1.73 m2, durante tres o más meses, acompañada por anormalidades estructurales o funcionales. México reporta una incidencia de 467/1 000 00 casos de ERC. La modalidad de diálisis más utilizada es la diálisis peritoneal y la complicación más común es la peritonitis. Se obtuvo la prevalencia de peritonitis en pacientes con diálisis peritoneal del HCM en 2021, determinar las comorbilidades asociadas a la ERC, la diferencia entre diálisis automatizada y continua ambulatoria, sus desenlaces y la mortalidad global. Estudio observacional, descriptivo, transversal. Pacientes con diálisis peritoneal atendidos durante 2021 en nefrología del HCM. Se recolectaron y analizaron los datos, utilizando estadística descriptiva e inferencial determinado la prevalencia de peritonitis, las diferencias entre la modalidad de diálisis peritoneal y los episodios de peritonitis. Se analizaron 339 pacientes atendidos en el HCM, durante un año, la prevalencia de peritonitis fue de 0.2625 peritonitis/paciente/año, las comorbilidades fueron la hipertensión (70.5%) y la diabetes mellitus (65.19%), entre los grupos de diálisis peritoneal automatizada y diálisis peritoneal continua ambulatoria no hubo diferencia y la mortalidad general fue 6.48%. La peritonitis es la principal complicación en diálisis peritoneal, la prevalencia en el HCM esta por abajo de la media del país y del mundo siendo esta del 26.25%. Las Guías de la Sociedad Internacional de la Diálisis Peritoneal recomiendan mantener una prevalencia por abajo de 0.5 episodios de peritonitis por paciente por año.

Abstract The definition of the Chronic Kidney Disease (CKD) is the decrease in glomerular filtration rate (GFR) below 60 ml/min/1.73 m2, for 3 or more months, accompanied by structural or functional abnormalities. Mexico reports an incidence of 467/1,000,000 cases of CKD. The most used dialysis modality is peritoneal dialysis, and the most common complication is peritonitis. We obtained the prevalence of peritonitis in patients with peritoneal dialysis in HCM in 2021, to determine the comorbidities associated with CKD, the difference between automated and continuous ambulatory dialysis, its outcomes, and overall mortality. Observational, descriptive, cross-sectional study. Patients with peritoneal dialysis attended during 2021 in HCM nephrology. Data were collected and analyzed using descriptive and inferential statistics to determine the prevalence of peritonitis and the differences between the modality of peritoneal dialysis and the episodes of peritonitis. The prevalence of peritonitis was 0.2625 peritonitis/patient/year, and the comorbidities were hypertension (70.5%) and diabetes mellitus (65.19%), between the groups of Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis there was no difference, and the overall mortality was 6.48%. Peritonitis is the main complication in peritoneal dialysis, the prevalence of HCM is below the country and world average of 26.25%. International Guidelines recommend maintaining a prevalence below 0.5 episodes of peritonitis per patient per year.

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INTRODUCCIÓN: Las infecciones asociadas a diálisis peritoneal constituyen una de las causas de morbimortalidad más importante en estos pacientes y la terapia antimicrobiana empírica y dirigida adecuada es fundamental para mejorar el resultado, por lo que es importante establecer la microbiología local. OBJETIVO: Revisar la experiencia clínica de cinco años del Hospital Carlos Van Buren de Valparaíso, Chile, describiendo las características clínicas y microbiológicas de los pacientes con episodios de peritonitis asociada a diálisis peritoneal. METODOLOGÍA De forma retrospectiva se accedió a los registros clínicos de aquellos pacientes mayores de 18 años que presentaron al menos un evento de peritonitis asociada a diálisis peritoneal. RESULTADOS: De un total de 26 episodios, 62% de los pacientes fueron de sexo femenino, con un promedio de edad de 53 años. La principal comorbilidad fue la hipertensión arterial (100%), y el dolor abdominal fue el síntoma más frecuente (85%), con una mortalidad general de 7,7%. En el laboratorio la leucocitosis, la proteína C reactiva (PCR) y la velocidad de hemosedimentación (VHS) fueron los hallazgos más importantes. Predominaron las cocáceas grampositivas (54%), seguido de bacilos gramnegativos no fermentadores y Enterobacterales en igual proporción (11,5% cada grupo). Casos aislados de Candida albicans y Pasteurella canis fueron identificados, y en 15% de los casos el cultivo resultó negativo. CONCLUSIÓN: Se pudo conocer las características clínicas y microbiológicas locales de esta patología, para así redefinir las directrices de manejo en la institución.

BACKGROUND: Infections associated with peritoneal dialysis are one of the most important causes of morbidity and mortality in these patients, and adequate empirical and targeted antimicrobial therapy are essential to improve the outcome, so it is important to establish the local microbiology. AIM: To review the clinical experience of 5 years at the Carlos Van Buren Hospital in Valparaíso, Chile, in order to know the clinical and microbiological characteristics of patients with episodes of peritonitis associated with peritoneal dialysis. METHODS: Retrospectively, the clinical records of those patients over 18 years of age who presented at least one peritonitis event associated with peritoneal dialysis were accessed. RESULTS: Of a total of 26 episodes, 62% of the patients were female, with a mean age of 53 years. The main comorbidity was arterial hypertension (100%), and abdominal pain was the most frequent symptom (85%), with an overall mortality of 7.7%. In the laboratory parameters, leukocytosis, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were the most important findings. Gram-positive cocci (54%) predominated, followed by Gram-negative non-fermenting and enterobacterial bacilli in the same proportion (11.5% each group). Isolated cases of Candida albicans and Pasteurella canis were identified, and in 15% of the cases the culture was negative. CONCLUSION: It was possible to know the local clinical and microbiological characteristics of this pathology, in order to redefine management guidelines for our institution.

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Las peritonitis secundarias constituyen una causa frecuente de internación y de uso de antibioticoterapia dentro de las infecciones intraabdominales. Realizamos un estudio retrospectivo, descriptivo y observacional de centro único desde enero a diciembre de 2021. El objetivo del estudio fue conocer la epidemiología local y adecuar el tratamiento empírico de las peritonitis secundarias de la comunidad. Se incluyeron pacientes mayores a 16 años con peritonitis secundaria, intervención quirúrgica, envío de material a cultivo y desarrollo microbiano de bacterias aerobias a través de la revisión de historias clínicas. Se analizaron cultivos de 36 pacientes, 64% de sexo masculino con una media de edad de 48,8 años. El 22% requirió internación en unidad de cuidados intensivos. La principal causa fue apendicitis aguda en el 61%, seguido por perforación secundaria a tumores. Se aislaron 43 bacterias aerobias (1,2 bacterias por episodio) siendo E. coli el microorganismo más frecuente. En la institución se utiliza piperacilina-tazobactam como tratamiento empírico. De acuerdo a las recomendaciones de la Sociedad Argentina de Infectología de 2018, en infecciones no complicadas podría utilizarse aminoglucósidos + metronidazol, optando por piperacilina-tazobactam en casos graves. No es recomendado como tratamiento empírico el uso de ampicilina-sulbactam y ciprofloxacina para infecciones graves o con difícil control del foco por la alta tasa de resistencia. En base a nuestro estudio podemos concluir que la epidemiología de los pacientes coincide con lo descrito en publicaciones nacionales, lo que nos lleva a reconsiderar el tratamiento empírico en casos leves, pudiendo optar por aminoglucósidos + metronidazol.

Secondary peritonitis is a frequent cause of hospital admission and an usual cause of use of antibiotic therapy in abdominal infections. We did a retrospective and observational study in one health center between January 2021 and December 2021. The aim of the study was to analyze the local epidemiology and adapt antibiotic empirical therapy of secondary community peritonitis. Patients aged 16 years and older with secondary peritonitis were included in this study. These patients needed surgical intervention and they had a positive culture with aerobic microorganism. We analyzed abdominal cultures from 36 patients, 64% men with a median age of 48.8 years. Twenty- two percent of these patients were admitted to intensive care unit. Acute appendicitis was the principal cause of secondary peritonitis in 61% of cases, followed by tumors. We found 43 aerobic bacterias (1.2 bacteria/episode), E.coli was the most frequent microorganism. In our hospital we use piperacillin- tazobactam for empirical treatment. According to the 2018 recommendations from the Argentine Society of Infectious Diseases, aminoglycosides + metronidazole can be used for uncomplicated intra-abdominal infections, and piperacillin-tazobactam should be used only in severe cases. However, ampicillin-sulbactam or ciprofloxacin is not recommended for severe cases or complicated infections due to the high resistance rates. Based on the finding of the study, it could be said that the epidemiology of the patients coincides with what was described in other national medical journals. Therefore, we should reconsider the use of aminoglycosides + metronidazole as empirical treatment for mild cases.

Assuntos

RESUMO

Pneumococcal peritonitis represents a small subset of patients suffering from invasive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

Assuntos