Posts filed under ‘Infecciones intraabdominales’


Medicina Legal de Costa Rica – Vol. 31 (1), Marzo 2014.

Pablo Orellana Soto

*Médico General, Código 12061 Universidad de Costa Rica.

Servicio de Emergencias Hospital Dr. Maximiliano

Peralta, Cartago, Costa Rica Correo electrónico:

La colangitis aguda es una patología descrita primera vez en 1877 por Jean Marie Charcot quien la describió como una “fiebre hepática”. Su presentación es variable, por lo que su diagnóstico no siempre es sencillo. Debido a esto se desarrollaron las Guías de Tokio las cuales ayudan a hacer más objetivos y globales los criterios diagnósticos, y a su vez dar criterios de severidad. El pilar de su manejo es la descompresión adecuada de la vía biliar, siendo la primera opción la colangiopancreatografía retrógrada endoscópica con esfinterotomía endoscópica, la cual no debe retrasarse en casos más severos…..


October 21, 2016 at 1:39 pm

Colangitis Aguda – Revisión de aspectos fundamentales

Rev. Medicina y Humanidades. Vol. III N°1-2, 2011

Dr. Humberto Flisfisch F.1  Ana Heredia C.2

1 Prof. Dpto. de Cirugía Sur. Facultad de Medicina Universidad de Chile.

2 Interno del Dpto. de Cirugía Sur. Facultad de Medicina Universidad de Chile.

La Colangitis Aguda ha sido una patología de gran morbimortalidad a través de la historia. En los años ’70 tenía una mortalidad habitual de un 50%, la que cae en los años ´80 a un 7% gracias al avance de las unidades de cuidado intensivo, advenimiento de nuevos antibióticos y técnicas de drenaje biliar. Sin embargo, durante los ´90 se reportaron tasas de mortalidad de 11 a 27%, y sigue siendo una enfermedad letal en ausencia de un tratamiento oportuno adecuado….


October 21, 2016 at 1:38 pm

Distribution of common pathogens in patients with pyogenic liver abscess in China: a meta-analysis

European J of Clinical Microb & Infec Diseases OCT 2016 V.35 N.10 P.1557–1565


Luo, X.-X. Yang, B. Tan, X.-P. Zhou

Pyogenic liver abscess (PLA) is a potentially life-threatening disease in many parts of the world, especially in Asia. The aim of this study was to quantify the proportion of common pathogens in patients with PLA in China, using a meta-analysis method based on systematic review of published studies. Several electronic databases were searched to identify the studies reporting the pathogens of PLA. We performed a meta-analysis to calculate the pooled proportion of pathogens and subgroup analysis among the included studies using R 3.1.1 software. In total, 183 studies were included in our final analysis, Klebsiella spp (54 %), Escherichia spp (29 %), Enterobacter spp (9 %), Proteus spp (6 %) and Pseudomonas spp (5 %) comprised the major gram-negative bacteria. Gram-positive bacteria mainly included Staphylococcus spp (13 %), Streptococcus spp (8 %) and Enterococcus spp (7 %). The distribution of pathogens in PLA patients were different in different economic regions in China. The proportion of Klebsiella spp had an upward tendency in recent years compared to other pathogens. In addition, the proportion of common pathogens in PLA patients with diabetes mellitus (DM) were carried out indicating that the dominant pathogens were Klebsiella spp (66 %), Escherichia spp (21 %) and Enterobacter spp (11 %). This meta-analysis showed that the main pathogens of PLA were Klebsiella spp, Escherichia spp, Staphylococcus spp, and Enterobacter spp in China. To ensure a precise estimate of the epidemiology of the pathogens, further large-scale or even a population-based study is needed.



October 2, 2016 at 9:44 am

Ceftazidime/avibactam: a novel cephalosporin/nonbeta-lactam beta-lactamase inhibitor for the treatment of complicated urinary tract infections and complicated intra-abdominal infections.

Drug Des Devel Ther. 2016 Jul 26;10:2379-86.

Hidalgo JA1, Vinluan CM2, Antony N3.

Author information

1UTEP/UT Austin Cooperative Pharmacy Program, College of Health Sciences, University of Texas at El Paso, El Paso; Department of Pharmacy, College of Pharmacy, The University of Texas at Austin, Austin.

2UTEP/UT Austin Cooperative Pharmacy Program, College of Health Sciences, University of Texas at El Paso, El Paso; Department of Pharmacy, College of Pharmacy, The University of Texas at Austin, Austin; Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.

3Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.


There has been greater interest in developing additional antimicrobial agents due to the increasing health care costs and resistance resulting from bacterial pathogens to currently available treatment options. Gram-negative organisms including Enterobacteriaceae and Pseudomonas aeruginosa are some of the most concerning threats due to their resistance mechanisms: extended-spectrum beta-lactamase production and Klebsiella pneumoniae carbapenemase enzymes. Ceftazidime is a third-generation broad-spectrum cephalosporin with activity against P. aeruginosa and avibactam is a novel nonbeta-lactam beta-lactamase inhibitor. Avycaz(®), the trade name for this new combination antibiotic, restores the activity of ceftazidime against some of the previously resistant pathogens. Avycaz was approved in 2015 for the treatment of complicated urinary tract infections, including pyelonephritis, and complicated intra-abdominal infections with the addition of metronidazole in patients with little to no other treatment options. This review article assesses the clinical trials and data that led to the approval of this antibiotic, in addition to its spectrum of activity and limitations.


August 27, 2016 at 12:27 pm

Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories

Clin. Microbiol. Rev. July 2013 26(3): 604-630

Carey-Ann D. Burnham and Karen C. Carroll

aDepartments of Pathology & Immunology and Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA

bDepartments of Pathology and Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types.

For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile.

This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI).

In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed.

Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described.

As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.


August 17, 2016 at 3:22 pm

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).

World J Emerg Surg. 2016 Jul 15;11:33.

Sartelli M, Weber DG, Ruppé E, Bassetti M, Wright BJ, Ansaloni L, Catena F, Coccolini F, Abu-Zidan FM, Coimbra R, Moore EE, Moore FA, Maier RV, De Waele JJ, Kirkpatrick AW, Griffiths EA, Eckmann C, Brink AJ, Mazuski JE, May AK, Sawyer RG, Mertz D, Montravers P, Kumar A, Roberts JA, Vincent JL, Watkins RR, Lowman W, Spellberg B, Abbott IJ, Adesunkanmi AK, Al-Dahir S, Al-Hasan MN, Agresta F, Althani AA, Ansari S, Ansumana R, Augustin G, Bala M, Balogh ZJ, Baraket O, Bhangu A, Beltrán MA, Bernhard M, Biffl WL, Boermeester MA, Brecher SM, Cherry-Bukowiec JR, Buyne OR, Cainzos MA, Cairns KA, Camacho-Ortiz A, Chandy SJ, Che Jusoh A, Chichom-Mefire A, Colijn C, Corcione F, Cui Y, Curcio D, Delibegovic S, Demetrashvili Z, De Simone B, Dhingra S, Diaz JJ, Di Carlo I, Dillip A, Di Saverio S, Doyle MP, Dorj G, Dogjani A, Dupont H, Eachempati SR, Enani MA, Egiev VN, Elmangory MM, Ferrada P, Fitchett JR, Fraga GP, Guessennd N, Giamarellou H, Ghnnam W, Gkiokas G, Goldberg SR, Gomes CA, Gomi H, Guzmán-Blanco M, Haque M, Hansen S, Hecker A, Heizmann WR, Herzog T, Hodonou AM, Hong SK, Kafka-Ritsch R, Kaplan LJ, Kapoor G, Karamarkovic A, Kees MG, Kenig J, Kiguba R, Kim PK, Kluger Y, Khokha V, Koike K, Kok KY, Kong V, Knox MC, Inaba K, Isik A, Iskandar K, Ivatury RR, Labbate M, Labricciosa FM, Laterre PF, Latifi R, Lee JG, Lee YR, Leone M, Leppaniemi A, Li Y, Liang SY, Loho T, Maegele M, Malama S, Marei HE, Martin-Loeches I, Marwah S, Massele A, McFarlane M, Melo RB, Negoi I, Nicolau DP, Nord CE, Ofori-Asenso R, Omari AH, Ordonez CA, Ouadii M, Pereira Júnior GA, Piazza D, Pupelis G, Rawson TM, Rems M, Rizoli S, Rocha C, Sakakhushev B, Sanchez-Garcia M, Sato N, Segovia Lohse HA, Sganga G, Siribumrungwong B, Shelat VG, Soreide K, Soto R, Talving P, Tilsed JV, Timsit JF, Trueba G, Trung NT, Ulrych J, van Goor H, Vereczkei A, Vohra RS, Wani I, Uhl W, Xiao Y, Yuan KC, Zachariah SK, Zahar JR, Zakrison TL, Corcione A, Melotti RM, Viscoli C, Viale P.


Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy.

Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance.

The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally.

The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs.

The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections).

The authors hope that AGORA, involving many of the world’s leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.


August 17, 2016 at 3:19 pm

Antimicrobial susceptibility of Gram-negative bacilli of community acquired intra-abdominal infections in a hospital at Buenos Aires, Argentina.

Rev Esp Quimioter. 2016 Jun 17.

Article in Spanish

Morganti L1, Córdova E, Cassini E, Gómez N, López Moral L, Badía M, Rodríguez C.

Author information

1Laura Morganti, Hospital General de Agudos Cosme Argerich. Pi y Margall 750, Ciudad Autónoma de Buenos Aires. Argentina.



Community acquired complicated intra-abdominal infections (cIAI) are a common condition. Few data are available about the level of antimicrobial resistance of Gram-negative bacteria isolated from community acquired cIAIs in Argentina.


Retrospective-prospective observational study (March 2010 to February 2012). Gram-negative bacteria antimicrobial susceptibility of isolates from community acquired cIAIs were evaluated.


During this period, a total of 85 patients were included and 138 pathogens were collected. Male sex: 58%. Median age: 33. Monomicrobial cultures were obtained in 49% of the cases. Ninety (65%) corresponded to Gram-negative organisms, and 48 (38%) to Gram-positive cocci. Gram-negative organisms most frequently observed were: Escherichia coli 76%, Klebsiella pneumoniae 8%, Pseudomonas aeruginosa 7% and Enterobacter spp. 6%. E. coli and K. pneumoniae showed a high percentage of strains resistance to ciprofloxacin of 37% and 29%, respectively. Similarly, resistance to ampicillin/sulbactam was observed in a 16% of the E. coli isolates. The prevalence of multiresistant Gram-negative organisms was 38%.


A high level of resistance to antimicrobials was observed in community acquired cIAIs, mainly to ciprofloxacin and ampicillin/sulbactam two of the most used antimicrobial for empirically treatment of cIAIs in our country. In addition a significant proportion of multiresistant Gram-negative organisms were identified.


August 10, 2016 at 8:36 am

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