Buscar en
Enfermedades Infecciosas y Microbiología Clínica
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica Duración del tratamiento antibiótico en la infección intraabdominal
Información de la revista
Vol. 28. Núm. S2.
Infecciones intraabdominales
Páginas 49-52 (Septiembre 2010)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 28. Núm. S2.
Infecciones intraabdominales
Páginas 49-52 (Septiembre 2010)
Acceso a texto completo
Duración del tratamiento antibiótico en la infección intraabdominal
Duration of antibiotic therapy in intraabdominal infections
Visitas
5951
Emilio Maseda
Autor para correspondencia
emilio.maseda@gmail.com

Autor para correspondencia.
, Fernando Gilsanz
Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Resumen

La duración del tratamiento antibiótico en los pacientes que presentan un proceso infeccioso se fundamenta en consideraciones empíricas. La infección intraabdominal no es ajena a este hecho. Por ello, la duración aconsejable del tratamiento antibiótico de la infección intraabdominal es un tema controvertido y no hay consenso a este respecto debido a la ausencia de estudios controlados que aporten suficiente evidencia científica. Una duración excesiva en el tratamiento antibiótico puede condicionar un mayor riesgo en el desarrollo de resistencias bacterianas y un aumento en los costes relacionados con el tratamiento. Estas consideraciones han tenido como consecuencia la exploración de estrategias con “tratamientos cortos” de 3-5 días con resultados alentadores. No obstante, el desarrollo de marcadores biológicos como la procalcitonina abre una puerta al tratamiento individualizado, de tal forma que la duración del tratamiento antibiótico en la infección intraabdominal, así como en otras infecciones, se ajuste a la respuesta individual de cada paciente.

Palabras clave:
Infección intraabdominal
Peritonitis secundaria
Duración del tratamiento antibiótico
Procalcitonina
Abstract

The duration of antibiotic treatment in patients with an infectious process is based on empirical considerations and those with intraabdominal infections are no exception. Therefore, the recommended duration of antibiotic therapy in intraabdominal infection is controversial and no consensus has been reached due to the lack of controlled studies that would provide sufficient scientific evidence. Excessive duration of antibiotic therapy can increase the risk of developing bacterial resistance as well as treatmentassociated costs. These considerations have led to the exploration of “short-term treatment” strategies, lasting 3-5 days, with encouraging results. However, the development of biomarkers such as procalcitonin opens the door to individualized treatment that might allow the duration of antibiotic treatment in intraabdominal and other infections to be individually tailed to patient response.

Keywords:
Intraabdominal infection
Secondary peritonitis
Duration of antibiotic treatment
Procalcitonin
El Texto completo está disponible en PDF
Bibliografía
[1.]
T. Calandra, J. Cohen.
The International Sepsis Forum Consensus Conference on definitions of infeccion in the intensive care unit.
Crit Care Med, 33 (2005), pp. 1538-1548
[2.]
S. Malhotra-Kumar, C. Lammens, S. Coenen, K. Van Herck, H. Goossens.
Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study.
[3.]
H.L. Evans, S.N. Lefrak, J. Lyman, R.L. Smith, T.W. Chong, S.T. McElearney, et al.
Cost of Gram-negative resistance.
[4.]
D.M. Livermore.
Has the era of untreatable infections arrived?.
J Antimicrob Chemother, 64 (2009), pp. 29-36
[5.]
N. Van de Sande-Bruinsma, H. Grundmann, D. Verloo, E. Tiemersma, J. Monen, H. Goossens, et al.
European Antimicrobial Resistance Surveillance System Group; European Surveillance of Antimicrobial Consumption Project Group. Antimicrobial drug use and resistance in Europe.
Emerg Infect Dis, 14 (2008), pp. 1722-1730
[6.]
S. Coenen, M. Ferech, F.M. Haaijer-Ruskamp, C.C. Butler, R.H. Vander Stichele, T.J. Verheij, et al.
ESAC Project Group. European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe.
Qual Saf Health Care, 16 (2007), pp. 440-445
[7.]
R.H. Vander Stichele, M.M. Elseviers, M. Ferech, S. Blot, H. Goossens.
European Survaillance of Antibiotic Comsuption (ESAC) Project Group. Hospital consumption of antibiotics in 15 European countries: results of the ESAC Retrospective Data Collection (1997-2002).
J Antimicrob Chemother, 58 (2006), pp. 159-167
[8.]
M.M. Neuhauser, R.A. Weinstein, R. Rydman, L.H. Danziger, G. Karam, J.P. Quinn.
Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use.
JAMA, 289 (2003), pp. 885-888
[9.]
P.M. Lepper, E. Grusa, H. Reichl, J. Högel, M. Trautmann.
Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa.
Antimicrob Agents Chemother, 46 (2002), pp. 2920-2925
[10.]
M.H. Jeon, S.H. Choi, Y.G. Kwak, J.W. Chung, S.O. Lee, J.Y. Jeong, et al.
Risk factors for the acquisition of carbapenem-resistant Escherichia coli among hospitalized patients.
Diagn Microbiol Infect Dis, 62 (2008), pp. 402-406
[11.]
P.J. Dennesen, A.J. Van der Ven, A.G. Kessels, G. Ramsay, M.J. Bonten.
Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia.
Am J Respir Crit Care Med, 163 (2001), pp. 1371-1375
[12.]
J. Chastre, M. Wolff, J.Y. Fagon, S. Chevret, F. Thomas, D. Wermert, et al.
Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.
JAMA, 290 (2003), pp. 2588-2598
[13.]
E.H. Ibrahim, S. Ward, G. Sherman, R. Schaiff, V.J. Fraser, M.H. Kollef.
Experience with a clinical guideline for the treatment of ventilator-associated pneumonia.
Crit Care Med, 29 (2001), pp. 1109-1115
[14.]
L.M. Dunbar, R.G. Wunderink, M.P. Habib, L.G. Smith, A.M. Tennenberg, M.M. Khashab, et al.
High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm.
Clin Infect Dis, 37 (2003), pp. 752-760
[15.]
K.G. Kyriakidou, P. Rafailidis, D.K. Matthaiou, S. Athanasiou, M.E. Falagas.
Short- versus long-course antibiotic therapy for acute pyelonephritis in adolescents and adults: a meta-analysis of randomized controlled trials.
Clin Ther, 30 (2008), pp. 1859-1868
[16.]
D.E. Karageorgopoulos, P.E. Valkimadi, A. Kapaskelis, P.I. Rafailidis, M.E. Falagas.
Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children.
Arch Dis Chile, 94 (2009), pp. 607-614
[17.]
B.A. Runyon, J.G. McHutchison, M.R. Antillon, E.A. Akriviadis, A.A. Montano.
Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients.
Gastroenterology, 100 (1991), pp. 1737-1742
[18.]
M. Schein, A. Assalia, H. Bachus.
Minimal antibiotic therapy after emergency abdominal surgery: a prospective study.
Br J Surg, 81 (1994), pp. 989-991
[19.]
A. Basoli, P. Chirletti, E. Cirino, N.G. D’Ovidio, G.B. Doglietto, D. Giglio, et al.
A prospective, double-blind, multicenter,randomized trial comparing ertapenem 3 vs. ≥ 5 días in community-acquired intraabdominal infection.
J Gastrointest Surg, 12 (2008), pp. 592-600
[20.]
E.S. Lennard, B.H. Minshew, E.P. Dellinger, M. Wertz.
Leukocytosis at termination of antibiotic therapy: its importance for intra-abdominal sepsis.
Arch Surg, 115 (1980), pp. 918-921
[21.]
E.S. Lennard, E.P. Dellinger, M.J. Wertz, B.H. Minshew.
Implications of leukocytosis and fever at conclusion of antibiotic therapy for intra-abdominal sepsis.
Ann Surg, 195 (1982), pp. 19-24
[22.]
E. Taylor, V. Dev, D. Shah, J. Festekjian, F. Gaw.
Complicated appendicitis: is there a minimum intravenous antibiotic requirement? A prospective randomized trial.
Am Surg, 66 (2000), pp. 887-890
[23.]
F. Alcocer, E. López, J.J. Calva, M.F. Herrera.
Antibiotic therapy in secondary peritonitis: towards a definition of its optimal duration.
Rev Invest Clin, 53 (2001), pp. 121-125
[24.]
E. Maseda, M. Lillo, L. Fernández, M.J. Villagrán, A. Gómez-Rice, F. Ramasco.
Septic shock due to community-acquired complicated intra-abdominal infection treated with ertapenem: outcome in 25 cases.
Rev Esp Anestesiol Reanim, 55 (2008), pp. 227-231
[25.]
J.S. Solomkin, J.E. Mazuski, J.S. Bradley, K.A. Rodvold, E.J. Goldstein, E.J. Baron, et al.
Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.
Clin Infect Dis, 50 (2010), pp. 133-164
[26.]
X. Guirao, J. Arias, J.M. Badía, J.A. García-Rodríguez, J. Mensa, F. Álvarez-Lerma, et al.
Recommendations in the empiric anti-infective agents of intra-abdominal infection.
Rev Esp Quimioter, 22 (2009), pp. 151-172
[27.]
B. Uzzan, R. Cohen, P. Nicolas, M. Cucherat, G.Y. Perret.
Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis.
Crit Care Med, 34 (2006), pp. 1996-2003
[28.]
K.L. Becker, R. Snider, E.S. Nylen.
Procalcitonin assay in systemic inflammation, infection, and sepsis: clinicalutility and limitations.
Crit Care Med, 36 (2008), pp. 941-952
[29.]
V. Nobre, S. Harbarth, J.D. Graf, P. Rohner, J. Pugin.
Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial.
Am J Respir Crit Care Med, 177 (2008), pp. 498-505
[30.]
P. Schuetz, M. Christ-Crain, R. Thomann, C. Falconnier, M. Wolbers, I. Widmer, et al.
Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial.
JAMA, 302 (2009), pp. 1059-1066
[31.]
D. Stolz, N. Smyrnios, P. Eggimann, H. Pargger, N. Thakkar, M. Siegemund, et al.
Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study.
Eur Respir J, 34 (2009), pp. 1364-1375
[32.]
B. Rau, C.M. Kruger, M.K. Schilling.
Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis.
Langenbecks Arch Surg, 389 (2004), pp. 134-144
[33.]
M. Hochreiter, T. Köhler, A.M. Schweiger, F.S. Keck, B. Bein, T. Von Spiegel, et al.
Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial.
Crit Care, 13 (2009), pp. R83
[34.]
L. Bouadma, C.E. Luyt, F. Tubach, C. Cracco, A. Álvarez, C. Schwebel, et al.
Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial.
Copyright © 2010. Elsevier España S.L.. Todos los derechos reservados
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos