Efectividad de los diferentes esquemas de tratamiento antibiótico usados en el tratamiento de la infección intraabdominal en hospitales de segundo y tercer nivel de Bogotá

dc.contributor.advisorSaavedra Trujillo, Carlos Humbertospa
dc.contributor.authorMuñetón López, Gerardo Antoniospa
dc.contributor.researcherFernanda Cárdenas, Luisa
dc.contributor.researcherSánchez, Laura Catalina
dc.contributor.researcherÁlzate, Juan Pablo
dc.contributor.researcherDiez Salazar, Yulissa Inés
dc.contributor.researcherArévalo Pereira, Kennedy
dc.contributor.researcherVelásquez, Juan Pablo
dc.contributor.researcherLasso, Andrés David
dc.contributor.researchgroupGrupo de Investigacion en enfermedades Infecciosasspa
dc.date.accessioned2021-02-01T21:09:33Zspa
dc.date.available2021-02-01T21:09:33Zspa
dc.date.issued2021-01-29spa
dc.description.abstractIntroducción: La infección intraabdominal genera estancia hospitalaria prolongada, ingreso a UCI, e intervenciones quirúrgicas múltiples. Es imperativo aplicar estrategias óptimas para disminuir su morbilidad. Existen diversos esquemas de antimicrobianos avalados para su tratamiento sin disponer de evidencia que resalte la superioridad de uno sobre otro. En Colombia, hasta el momento solo se han realizado estudios descriptivos sobre los antibióticos usados y el perfil de resistencia de nuestros microorganismos, sin embargo, no se tienen datos comparativos de efectividad, que permitan conocer qué antibiótico es superior en términos de resolución de la enfermedad. El objetivo de este trabajo fue realizar una comparación directa de la efectividad entre los esquemas de antimicrobianos más usados en Bogotá. Métodos: Estudio de cohorte retrospectivo analítico realizado en pacientes con infección intraabdominal los cuales requirieron cirugía abdominal y administración de alguno de 5 esquemas antibióticos (ampicilina-sulbactam, amikacina-clindamicina, amikacina-metronidazol, piperacilina tazobactam y cefuroxima-metronidazol). Se comparó la efectividad de los tratamientos mediante un desenlace compuesto por 5 variables (Cambio de antibiótico debido a no mejoría clínica, requerimiento de reintervención quirúrgica, infección postquirúrgica, Cambio de antibiótico por resistencia bacteriana y mortalidad intrahospitalaria). Se evaluó la relación de cada esquema antimicrobiano con el desenlace falla terapéutica mediante un análisis bivariado y posteriormente se realizó un modelo de regresión logística para encontrar la asociación independiente de cada esquema antibiótico con el desenlace primario ajustando por variables confusoras. Resultados: Se incluyeron 593 pacientes. 229(39%) recibieron ampicilina-sulbactam, 170(28%) amikacina-clindamicina, 77(13%) amikacina-metronidazol, 83(14%) piperacilina-tazobactam y 34(6%) cefuroxime-metronidazol. 22% presentaron falla terapéutica. Las principales causas fueron la reintervención no programada y la infección postquirúrgica. En el análisis multivariado, se evidencio que ninguno de los esquemas de tratamiento antibiótico evaluados presentó asociación significativa de riesgo o protectora con el desenlace primario. Únicamente permanecieron con asociación de riesgo significativa, las variables: Mayor de 70 años (OR 2.08IC95%1.04-4.18), infección intraabdominal complicada (OR 3.36 IC95%1.4-8.07) y Score WSES (OR 1.31 IC95%(1.18-1.45). El control adecuado del foco infeccioso (OR 0.16 IC95%0.05-0.45) y la hospitalización el centro hospitalario 2 (OR 0.30 IC95%0.14-0.63), se identificaron como factores protectores. Ningún esquema de antibiótico se asoció a mayor estancia hospitalaria, lesión renal o estancia en unidad de cuidado intensivo. Conclusión: No existen diferencias significativas en la tasa de falla terapéutica alcanzada entre los diferentes esquemas de antibiótico estudiados. . Este desenlace depende de factores de riesgo relacionados con la severidad de la enfermedad al momento de la intervención quirúrgica.spa
dc.description.abstractIntroduction: Intraabdominal infection frequently results in prolonged in-hospital lengh-of-stay, critical care unit requirements and multiple surgical procedures. Therefore, it is necessary to apply optimal strategies to decrease related morbidity. Diverse antimicrobial agents are available and endorsed for intraabdominal infection treatment, without firm evidence indicating superiority of one over the others. In Colombia, descriptive studies have taken place regarding the type of antibiotics used and the resistance profile of selected microorganisms; however, there is no data on the comparative efectiveness of the different schemes used, in terms of resoving the disease. Methods: A retrospective cohort study was completed by comparing treatment efectiveness of 5 different antibiotic in patients who had surgery after intraabdominal infection (ampicillin-sulbactam, clindamycin plus amikacin, piperacillin-tazobactam, amikacin plus metronidazol, and cefuroxime plus metronidazol); analysis was based on a composed outcome of 5 variables (Change of antibiotic due to no clinical improvement, requirement of surgical intervention, postoperative infection, change of antibiotic due to antimicrobial resistance, and in-hospital mortality). Association of each antibiotic protocol to therapuetic failure outcome was assessed through bivariate analysis, and logistic regression analysis was carried out to find independent association of each antibiotic to the primary outcome, adjusting by confounding variables. Results: 593 individuals were included. 229 (39%) were prescribed ampicillin-sulbactam, 170 (28%) clindamycin plus amikacin, 77 (13%) amikacin plus metronidazol, 83(14%) piperacillin-tazobactam, and 34 (6%) cefuroxime plus metronidazol. 22% of all individuals had therapeutic failure. Most relevant causes were unscheduled reintervention and posoperative infection. Multivariate analysis showed none of the evaluated antibiotic protocols had a significant association as a risk or protective factor to the primary outcome. The only variables to have a significant association for higher risk were age > 70 yo (OR 2.08 CI 95%1.04-4.18), complicated intraabdominal infection (OR 3.36 IC 95%1.4-8.07), and WSES Score (OR 1.31 IC 95%1.18-1.45). Adequate control of the primary source of infection (OR 0.16 IC 95%0.05-0.45) and hospitalization at health center number 2 (OR 0.30 IC95%0.14-0.63) were identified as protective factors. None of the evaluated antibiotic protocols was found to be associated to a higher in-hospital lengh-of-stay, to kidney failure or to critical care unit requirement. Conclusion: There are no significant differences between the rate of therapeutic failure amongst the different antibiotic protocols we evaluated. This outcome depends heavily on risk factors related to disease severity when the surgical intervention takes place.eng
dc.description.degreelevelEspecialidades Médicasspa
dc.format.extent78spa
dc.format.mimetypeapplication/pdfspa
dc.identifier.citationMuñetón López, G. A. (2021). Efectividad de los diferentes esquemas de tratamiento antibiótico usados en el tratamiento de la infección intraabdominal en hospitales de segundo y tercer nivel de Bogotá [Tesis de especialidad, Universidad Nacional de Colombia]. Repositorio Institucional.spa
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/79018
dc.language.isospaspa
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotáspa
dc.publisher.programBogotá - Medicina - Especialidad en Infectologíaspa
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dc.subject.ddc610 - Medicina y saludspa
dc.subject.proposalIntraabdominalspa
dc.subject.proposalIntraabdominaleng
dc.subject.proposalInfectioneng
dc.subject.proposalInfecciónspa
dc.subject.proposalAntibioticospa
dc.subject.proposalAntibioticeng
dc.subject.proposalReinterventioneng
dc.subject.proposalReintervenciónspa
dc.subject.proposalPostquirúrgicaspa
dc.subject.proposalPostsurgicaleng
dc.titleEfectividad de los diferentes esquemas de tratamiento antibiótico usados en el tratamiento de la infección intraabdominal en hospitales de segundo y tercer nivel de Bogotáspa
dc.typeTrabajo de grado - Especialidad Médicaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdccspa
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aaspa
dc.type.contentTextspa
dc.type.driverinfo:eu-repo/semantics/masterThesisspa
dc.type.versioninfo:eu-repo/semantics/acceptedVersionspa
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2spa

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Tesis de Especialidad Médica en Infectología

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