MANAGEMENT OF ANTIMICROBIALS IN INTRA-ABDOMINAL INFECTIONS UNDER THE PERSPECTIVE OF ANTIMICROBIAL RESISTANCE IN THE SURGERY SERVICE OF THE GENERAL HOSPITAL OF LATACUNGA

Abstract

The development of resistance to antimicrobials in intra-abdominal infections requires special care in the selection of the antibiotic scheme to treat them. Objective: We intend to review the primary and secondary antibiotic schemes used in a surgery service from the perspective of antimicrobial resistance. Materials and methods: 165 cultures were performed in the same number of patients who underwent surgery for intra-abdominal infections in a level II hospital, of which 134 developed species of enterobacteria, 47 sensitive to antimicrobials and 87 resistant to some degree to available antibiotics. Results: The primary antibiotic scheme included the following antibiotics: ceftriaxone/metronidazole 75.37%, Ampicillin/sulbactam 17.91%, ceftriaxone (alone), 2.99%, ciprofloxacin/metronidazole, 2.24% and ampicillin/metronidazole 1 .49%. The enterobacteria identified were in order of frequency: it was E. coli (79%), K. pneumonia (10%), P. aeruginosa (5%), P. vulgaris (4%), other less frequent enterobacteria were, C. freundi and E. cloacale.(2%), K. oxytoca, hafnia A, K. ozonea and S. marcenses less than 2%. Enterobacteriaceae resistance: 89.76% to Ampicillin, 66.14% to cephalothin and 66.20% to sulfa drugs. Regarding E. coli, the percentages of resistance were the following: Ampicillin 89.62%, Cefalothin 62.26%; Greater sensitivity to: Aminoglycosides 85.85%, Ciprofloxacin 66.04%, with low percentages of sensitivity to third generation Cephalosporins (63 to 67%). They maintain high levels of sensitivity to imipenem (97.71% and 99.6%). In 40% of cases, a new antibiotic scheme was changed, which represented the following percentages: ceftriaxone/metronidazole in 20 patients (35.71%), followed by the piperacillin/tazobactam scheme in 10 patients (17.86%), Imipenem in 7 patients (12.5%) and, in lower percentages, several antimicrobials identified as effective in the treatment due to the sensitivity levels for the identified enterobacteria. Hospital stay was an average of 12.63 days, complications occurred in 34% of patients and overall mortality in 15.67%. Conclusions: in level II hospitals in Ecuador, the primary antimicrobial scheme may be the combination of ceftriaxone/meronidazole, although in selected cases an aminoglycoside/metronidazole could be associated. It is convenient to reserve antibiotic schemes with carbapenems (imepenem) for cases with resistance to antimicrobials of the PDR type.