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2002, Número 4

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Med Crit 2002; 16 (4)


Sepsis abdominal

Juan Pedro Chávez PJP

Idioma: Español
Referencias bibliográficas: 42
Paginas: 124-135
Archivo PDF: 94.83 Kb.


RESUMEN

La sepsis abdominal tiene una incidencia similar a la neumonía y bacteremia en la unidad de cuidados intensivos y por lo tanto el pronóstico y el costo de atención son similares. La sepsis abdominal es una respuesta sistémica a un proceso infeccioso localizado. La peritonitis aguda tiene elevada mortalidad y es la primera etapa de la sepsis abdominal; los sobrevivientes a ésta desarrollan abscesos siete días más tarde. Las principales manifestaciones de la peritonitis son dolor abdominal, fiebre, resistencia muscular y silencio abdominal. Son herramientas útiles para completar el diagnóstico de sepsis abdominal la ultrasonografía, tomografía computada y estudios con radioisótopos. El tratamiento de la sepsis abdominal incluye el drenaje de los focos infecciosos, apoyo sistémico y el empleo de antibióticos específicos. Son factores de mal pronóstico: edad > 65 años, número de cirugías (más de dos), peritonitis generalizada, desnutrición, choque séptico y falla orgánica múltiple.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Shands JW. Empiric antibiotic therapy of abdominal sepsis and serious perioperative infections. Surg Clin North Am 1993;73:291-306.

  2. McClean KL, Sheehan GJ, Harding GKM. Intraabdominal infection. A review. Clin Infect Dis 1994;19:100-16.

  3. Malangoni MA. Evaluation and management of tertiary peritonitis. Am Surg 2000;66:157-61.

  4. Bartlett JG. Sepsis intraabdominal. Med Clin North AM 1995;79:595-612.

  5. Anderson LD, Fearon CH, Grant IS. Laparotomy for abdominal sepsis in the critically ill. Br J Med 1996;82:535-9.

  6. Mier J et al. Complicaciones de la apendicectomía. La importancia del diagnóstico temprano. Cir y Ciruj 1994;62:132-7.

  7. Carrillo AV. Perforación intestinal por fiebre tifoidea. Cir y Ciruj 1993;60:133-41.

  8. Schein M et al. Abdominal contamination, infection and sepsis: a continnum. Br J Surg 1997;84:269-72.

  9. Offenbartl K, Bengmark S. Intraabdominal infections and Gut origin sepsis. World J Surg 1990;14:191-5.

  10. Fabian TC. Prevention of infections following penetrating abdominal trauma. Am J Surg 1993; 165(suppl 2A):14S-19S.

  11. Christou N. Systemic and peritoneal host defense in peritonitis. World J Surg 1990; 14:184-90.

  12. Steeb G et al. Infections within the peritoneal cavity: a historical perspective. Am J Surg 2000;66:98-104.

  13. Simmen HP, Blaser J. Analisis of pH and PO2 in abscesses, peritoneal fluid, and drainage fluid in the presence or absence of bacterial infection during an after abdominal surgery. Am J Surg 1993;165:24-26.

  14. Shyr-Chyr Chen et al. Accuracy of ultrasonography in the diagnosis of peritonitis compared whit the clinical impression of the surgeon. Arch Surg 2000;135:170-4.

  15. Shaw JHF, Koea JB. Metabolic basis for management of the septic surgical patient. World J Surg 1993;17:154-64.

  16. Redl-Wenzi EM et al. The effects of norepinephrine on hemodynamics and renal function in severe septic shock states. Intensive Care Med 1993;19:151-4

  17. Seiler CA et al. Conservative surgical treatment of diffuse peritonitis. Surgery 2000;127:178-84.

  18. Parc Yann et al. Management postoperative peritonitis after anterior resection. Dis Colon Rectum 2000;43:579-89.

  19. Bosscha K et al. Open management of the abdomen an planned reoperations in severe bacterial peritonitis. Eur J Surg 2000;166:44-9.

  20. Howard TJ et al. Classification and treatment of local septic complications in acute pancreatitis. Am J Surg 1995; 170:44-50.

  21. Fansler RF et al. Polypropylene mesh closure of the complicated abdominal wound. Am J Surg 1995;170:15-18.

  22. Sautner T et al. Does reoperation for abdominal sepsis enhance the inflammatory host response? Arch Surg 1997;132:250-5.

  23. Riché FC. Inflammatory cytokine response in patients with septic shock secondary to generalized peritonitis. Crit Care Med 2000; 28:433-7.

  24. Scripcariu V et al. Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection. Br J Surg 1994;81:1475-8.

  25. Wroblicka JT, Kuligowska E. One-Step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses. Am J Radiol 1998;170:1197-1203.

  26. Cunha BA. Antibioticoterapia contra la sepsis. Med Clin North Am 1995;79:551-8.

  27. Ambrose PG et al. Antibiotic use in the critical care unit. Crit Care Clin 1998;14:283-308.

  28. DiPiro JT, Fortson NS. Combination antibiotic therapy in the management of intra-abdominal infection. Am J Surg 1993;165(suppl 2A):82S-88S.

  29. Barie PS et al. Cefepima más metronidazol en el tratamiento de infecciones intraabdominales: eficacia clínica y costo efectividad. Arch Surg 1997;132:1294-1302.

  30. Charbonneau P. Review of piperacillin/tazobactam in the treatment of bacteremic infections and summary of clinical efficacy. Intensive Care Med 1994;20:S43-S48.

  31. Walker AP et al. Efficacy of beta-lactamase inhibitor combination for serious intra-abdominal infections. Am Surg 1993;217:115-21.

  32. Basoli A et al. Imipenem/citalastin (1.5 g daily) versus meropenem (3.0 g daily) in patients with intra-abdominal infections: Results of a prospective, randomized, multicentre trial. Scand J Infect Dis 1997;29:503-8.

  33. Buckley MM et al. Imipenem/Cilastatin. A reappraisal of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy. Drugs 1992;44:408-44.

  34. Solomkin JS et al. Results of a multicenter trial comparing Imipenem/Cilastatin to tobramycin/clindamycim for intra-abdominal infections. Am Surg 1990;212:581-91.

  35. Pitkin D et al. Comparison of the activity of meropenem with that of other agents in the treatment of intraabdominal, obstetric/gynecologic, and skin and soft tissue infections. Clin Infect Dis 1995;20(suppl 2):S372-5.

  36. Saha SK. Efficacy of metronidazole lavage in treatment of intraperitoneal sepsis. Dig Dis Sci 1996;41:1313-18.

  37. Tetteroo GWM, Wagenvoort JHT, Bruining HA. Role of selective decontamination in surgery. Br J Surg 1992;79:300-4.

  38. Wickel DJ et al. Poor outcome from peritonitis is caused by disease acuity and organ failure, not recurrent peritoneal infection. Am Surg 1997;225:744-56.

  39. Bining A, Frolich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2,003 patients. Br J Surg 1994;81:209-13.

  40. Pacelli F et al. Prognosis in intra-abdominal infections. Arch Surg 1996;131:641-5.

  41. Bosscha K et al. Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis. Br J Surg 1997;84:1532-4.

  42. McLauchlan GJ et al. Outcome of patients with abdominal sepsis treated in an intensive care unit. Br J Surg 1995;82: 524-9.




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