RESUMO
A substantial epidemiologic change in the etiology of spontaneous bacterial peritonitis (SBP) has been observed in recent years. Gram-positive, as well as multiresistant bacteria, have emerged as an important cause of SBP mainly among hospitalized patients. In this setting, SBP caused by methicillin-resistant Staphylococcus aureus (MRSA) could become a major clinical problem in the near future. We present two cases of SBP due to MRSA without clinical response to vancomycin, even though in vitro sensitivity was observed in both cases. We review the current literature on the incidence and clinical significance of SBP due to MRSA infection in cirrhotic patients, as well as its prevention and treatment.
Assuntos
Cirrose Hepática/complicações , Resistência a Meticilina , Peritonite/microbiologia , Infecções Estafilocócicas , Adulto , Idoso , Feminino , Humanos , Masculino , Staphylococcus aureus/efeitos dos fármacosRESUMO
En los últimos años, se ha producido un importante cambio epidemiológico en la etiología de la peritonitis bacteriana espontánea (PBE). Se ha registrado, especialmente en el ámbito intrahospitalario, un notable incremento en la proporción de casos originados tanto por bacterias grampositivas como por microorganismos resistentes a antibióticos. En este contexto, se ha señalado que la PBE causada por Staphylococcus aureus resistente a meticilina (SARM) podría constituir una problema relevante en un futuro próximo. Se presentan 2 casos de PBE por SARM, sin respuesta clínica al tratamiento con vancomicina en ninguno de ellos, a pesar de detectarse sensibilidad in vitro a dicho antibiótico. Se revisa la literatura médica acerca de la incidencia y la relevancia clínica de la PBE por SARM en pacientes cirróticos, y se discute la evidencia acerca de las posibilidades de prevención y tratamiento de dicho proceso
A substantial epidemiologic change in the etiology of spontaneous bacterial peritonitis (SBP) has been observed in recent years. Gram-positive, as well as multiresistant bacteria, have emerged as an important cause of SBP mainly among hospitalized patients. In this setting, SBP caused by methicillin-resistant Staphylococcus aureus (MRSA) could become a major clinical problem in the near future. We present two cases of SBP due to MRSA without clinical response to vancomycin, even though in vitro sensitivity was observed in both cases. We review the current literature on the incidence and clinical significance of SBP due to MRSA infection in cirrhotic patients, as well as its prevention and treatment
