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Resumen
A pesar de la mejora en el conocimiento de la fisiopatología de la infección grave, de las técnicas diagnósticas, del tratamiento antibiótico, de los cuidados perioperatorios y de la técnica quirúrgica, todavía un porcentaje relevante de pacientes afectados de infección intrabdominal (IAB) desarrolla estadios avanzados de infección y precisa el ingreso en las unidades de cuidados intensivos.
El éxito del tratamiento de la IAB es multifactorial y es necesario saber que la mejor pauta antibiótica puede fracasar si el control del foco de la infección es deficiente o difícil de conseguir. El presente capítulo discute la adecuación del tratamiento antibiótico empírico y los principales patógenos que se han asociado con el fracaso terapéutico. Además, se analizan las situaciones y pacientes de riesgo en los que es precisa una cobertura antibiótica más amplia. El uso excesivo de antibióticos en espectro, cantidad y duración, sin tener en cuenta estos preceptos, puede conducirnos a un modelo de atención poco sostenible en un entorno amenazado por la escasez en la investigación y desarrollo de nuevas moléculas necesarias para atender la aparición de patógenos resistentes a los antibióticos actuales.
Palabras clave:
Infección intraabdominal
Factores de riesgo de fracaso terapéutico
Adecuación del tratamiento antibiótico
Abstract
Despite improvements in our knowledge of the physiopathology of severe infection, diagnostic methods, antibiotic therapy, postoperative care and surgical techniques, a substantial number of patients with intraabdominal infection (IAI) will develop advanced stages of septic insult requiring admission to the intensive care unit.
The success of treatment of IAI is multifactorial and the best antibiotic protocol may be insufficient unless adequate control of the focus of infection has been achieved. The present article discusses the appropriacy of empirical antibiotic therapy and the main pathogens associated with treatment failure. We also analyze the patients at risk of infection with microorganisms requiring broad-spectrum antimicrobial coverage. However, excessive antibiotic treatment, in terms of either spectrum or duration, could jeopardize future patients in an environment already threatened by the scarcity of research and development into new molecules required for the emergence of pathogens resistant to current antibiotics.
Keywords:
Intrabdominal infection
Risk factors of antibiotic treatment failure
Appropriateness of empirical antibiotic therapy
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