Peritonitis En Dialisis Peritoneal

UNIVERSIDAD DEL VALLE DE MEXICO: ARTÍCULO DE INVESTIGACION

UNIVERSIDAD DEL VALLE DE MEXICO

INCIDENCIA DE PERITONITIS EN PACIENTES CON ENFERMEDAD RENAL CRÓNICA EN DIÁLISIS PERITONEAL Y ANTIBIOTICOTERAPIA ADMINISTRADA
MIP Christian Alejandro Lara Hernandez 1, Dr. Arturo Duarte Ortuño², Dr. Alonso Echegollen Guzman², Dra. Marisol Rodriguez Mandujano 3

1 Médico Interno de Pregrado, Facultadde Medicina, Universidad del Valle de México, Campus Victoria, Tam. México. 2 Coordinación de Investigación Científica Universidad del Valle de México, Campus Victoria, Tam. México. 3 Especialista en medicina integral, Hospital General, Dr. Norberto Treviño Zapata

ABSTRACT OBJECTIVE: To determine the incidence of peritonitis in intermittent peritoneal dialysis (IPD) patients, major clinicalmanifestations, diagnostic tests and treatment.

METHODS: This was an observational, retrospective study of patients with advanced chronic kidney disease on intermittent peritoneal dialysis at the General Hospital of Ciudad Victoria Tamaulipas from March 2010 to March 2011.

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UNIVERSIDAD DEL VALLE DE MEXICO: ARTÍCULO DE INVESTIGACION RESULTS: 49 cases with peritonitis were documented out of142 patients for an incidence of 0.34. 16 patients (33%) had episodes of peritonitis detected on leukocyte count, but only 7 showed clinical symptoms and none of them had a Gram report. Only 9 crops were indicated, but only 6 reports were available. S. Aureus was the most common agent isolated (50% of all cases). 11 patients (69%) received antimicrobial empiric treatment; quinolones andcephalosporins.

CONCLUSIONS Chronic kidney disease is a non solved problem affecting mainly diabetic and hypertensive patients over 60 years old. Treatment is based in replacement kidney function based on PD, and the intermittent mode corresponds to a third of the population in this study.

Peritonitis is the most common complication in these patients, so the typical clinical presentation of abdominalpain, fever, and turbidity in the peritoneal fluid, makes us suspicious of his presence and carry white blood cell counts that confirm its presents above 100 leukocytes/mm3 with more than 50% polymorphonuclear cells. The Gram report is a guide to detect the causal agent for the initiation of empiric treatment, so the request and confirmation is mandatory in all such cases. In this study, initialmanagement was focused on antibiotic gram negative and gram finally reported positive, requiring modification, although according to the empirical antibiotic therapy should be broad spectrum to cover both gram positive and negative and the association of vancomycin, aminoglycosides, cephalosporins and quinolones are recommended, and are modified by crop results of peritoneal fluid. According tothe results obtained, it was confirmed that the main causal agents of bacterial peritonitis associated with peritoneal dialysis are gram positive, specifically S. aureus, as mentioned in different series reported in the literature.

Keywords: Peritonitis, dialysis, chronic kidney disease, antibiotic, complications. RESUMEN OBJETIVOS: Conocer la incidencia de diálisis peritoneal intermitente, lasprincipales manifestaciones clínicas, los métodos

presentación de peritonitis en pacientes en 2

UNIVERSIDAD DEL VALLE DE MEXICO: ARTÍCULO DE INVESTIGACION diagnósticos que se realizan y como ellos intervienen en el tratamiento. MATERIAL Y MÉTODOS: Se trata de un estudio retrospectivo, Insuficiencia transversal, realizado Renal en observacional pacientes en con CONCLUSIONES La EnfermedadRenal Crónica es un problema que afecta a gran parte de la población, principalmente mayores de 60 años, diabéticos e hipertensos. El tratamiento sustitutivo de la función renal se basa en la Diálisis Peritoneal, y la modalidad Intermitente corresponde a una tercera parte de la población en este estudio. La tinción de Gram nos orienta acerca del agente causal para el inicio de manejo empírico, por...