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
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Infecções Urinárias/microbiologia , Infecções Urinárias/tratamento farmacológico , Testes de Sensibilidade Microbiana , Sepse/microbiologia , Sepse/tratamento farmacológico , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Chile/epidemiologia , Estudos Prospectivos , Ureterolitíase/complicações , Ureterolitíase/tratamento farmacológicoRESUMO
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.