Gasparotto Ana Maria, Gianecini Ariel, Kasparian Andres, Kremer Luis, Rocchi Marta, Quinteros Greco Carlos, Ocaña Carrizo Ana Valeria, Navarro Mercedes, Monterisi Aida
Universidad Nacional de Cordoba. Facultad de Ciencias Médicas. Departamento de Bacteriología.
Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Hospital Nacional de Clínicas. Departamento de Bacteriología.
Rev Fac Cien Med Univ Nac Cordoba. 2022 Sep 16;79(3):280-284. doi: 10.31053/1853.0605.v79.n3.36024.
Streptococcus pneumoniae (Spn) is occasionally implicated as a cause of intra-abdominal infection (IIASpn) that can be 1) spontaneous bacterial peritonitis (SBP) in elderly patients with previous peritoneal disease, associated with cirrhosis, in most of the cases 2) associated or adjacent to an intra-abdominal organ or postsurgical. (IIAbq) 3) peritonitis in previously healthy young women (PHYW). Our objective is report 18 cases of IIASpn describing: clinical presentation, comorbidities, need for surgery, microbiological findings, sensitivity of Spn to antimicrobials, therapeutic behavior, and evolution.
study of 18 adult patients with IIASpn. Clinical and microbiological characteristics and evolution of infections were analyzed.
IIASpn occurred in 9 PHYW, 6 men and 1 woman with SBP, and 2 men with appendicitis. The PHYW were operated on (4 pelviperitonitis, 3 salpingitis, 2 and tubo ovarian abscess) and had a favorable evolution. In the intraoperative samples, pure culture of Spn sensitive to penicillin was isolated. Three of four patients had positive blood culture. Five of seven patients with SBP died and in the peritoneal fluid developed Spn in pure culture. A large percentage of strains presented decreased sensitivity to penicillin. Four of five had a positive blood culture. Patients with appendicitis had favorable evolution.
IIASpn in PHYW was the most frequent presentation, surgery played a significant role in treatment and the clinical response was excellent. The second presentation occurred in elderly patients with cirrhosis, most of whom died. Appendicitis was the third presentation in patients who evolved favorably.
肺炎链球菌（Spn）偶尔被认为是腹腔内感染（IIASpn）的病因，这种感染可以是：1）既往有腹膜疾病的老年患者发生的自发性细菌性腹膜炎（SBP），大多数情况下与肝硬化有关；2）与腹腔内器官相关或相邻，或术后发生的感染（IIAbq）；3）既往健康的年轻女性发生的腹膜炎（PHYW）。我们的目的是报告18例IIASpn病例，描述其临床表现、合并症、手术需求、微生物学检查结果、Spn对抗菌药物的敏感性、治疗行为及病情演变。
对18例成年IIASpn患者进行研究。分析感染的临床和微生物学特征及病情演变。
IIASpn发生于9例既往健康的年轻女性、6例男性和1例发生SBP的女性以及2例患阑尾炎的男性。既往健康的年轻女性接受了手术（4例盆腔腹膜炎、3例输卵管炎、2例输卵管卵巢脓肿），病情演变良好。术中样本分离出对青霉素敏感的Spn纯培养物。4例患者血培养阳性。7例SBP患者中有5例死亡，腹腔积液中培养出Spn纯培养物。很大比例的菌株对青霉素敏感性降低。5例中有4例血培养阳性。阑尾炎患者病情演变良好。
既往健康的年轻女性发生的IIASpn最为常见，手术在治疗中起重要作用，临床反应良好。第二种情况发生于肝硬化老年患者，其中大多数死亡。阑尾炎是病情演变良好的患者中的第三种情况。
