Uruguay is a South American country (3241003 inhabitants) where renal replacement treatment is universally available. The aim of this study was to analyze the incidence and outcome of peritonitis, and the causative organisms and their sensitivity, in order to recommend an empiric initial antibiotic treatment. A retrospective descriptive study of all peritonitis during the period 2004 – 2005 was performed (144 peritonitis, 44% due to gram-positive bacteria). We conclude that the high prevalence of methicillin-resistant coagulase-negative staphylococci justifies the use of vancomycin in the national empiric initial antibiotic protocols.
Aim IgA nephropathy (IgAN), the most common glomerulopathy worldwide and in Uruguay, raised treatment controversies. The study aimed to analyze long-term IgAN outcomes and treatment. Methods A retrospective analysis of a Uruguayan IgAN cohort, enrolled between 1985 and 2009 and followed up until 2020, was performed. The Ethics Committee approved the study. The inclusion criteria were (a) biopsy-proven IgAN; (b) age ≥12 years; and (c) available clinical, histologic, and treatment data. The patients were divided into two groups, with immunosuppressive (IS) or without (NoIS) treatment. Outcomes (end-stage kidney disease/kidney replacement therapy [ESKD/KRT] or all-cause death) were obtained from mandatory national registries. Results The study population included 241 patients (64.7% men), median age 32 (19.5) years, baseline blood pressure <130/80 mmHg in 37%, and microhematuria in 67.5% of patients. Baseline proteinuria, glomerulosclerosis, and a higher crescent percentage were significantly more frequent in the IS group. Proteinuria improved in both groups. Renal survival at 20 years was 74.6% without difference between groups. In the overall population and in the NoIS group, bivariate Cox regression analysis showed that baseline proteinuria, endocapillary hypercellularity, tubule interstitial damage, and crescents were associated with a higher risk of ESKD/KRT or death, but in the IS group, proteinuria and endocapillary hypercellularity were not. In the multivariate Cox analysis, proteinuria in the NoIS group, crescents in the IS group and tubule interstitial damage in both groups were independent risk factors. Conclusion The IS group had more severe risk factors than the NoIS group but attained a similar outcome.
La peritonitis en diálisis peritoneal (DP) es una complicación grave, y Acinetobacter raramente la causa. Analizamos la prevalencia, sensibilidad, tratamiento y evolución de peritonitis por Acinetobacter en tres centros de DP. Material y métodos: Se incluyeron pacientes mayores de 18 años, asistidos entre 1/1/2008 y 31/12/2018. Resultados: Se registraron 336 peritonitis (0,39 peritonitis/paciente-año): 139 (41.36%) por gram positivos, 95 (28.27%) por gram negativos, 18 (5.35%) por hongos y 80 (23.80%) por cultivos sin desarrollo. En 10 (2.97%) se aisló Acinetobacter. Tenían una edad media de 53.5 ± 15.7 años, el 50% eran diabéticos, en DP por 24 ± 19 meses, y 8 de los10 con antecedente de peritonitis previa. La especie de Acinetobacter más frecuente fue Baumannii (5/10), seguida por Ursingii (2/10) y Acinetobacter L woffii (1/10). El tratamiento inicial fue según el protocolo nacional: vancomicina y amikacina intraperitoneales, y en todos se realizó cambio de antibiótico al identificar microorganismo. Presentaron cura clínica y microbiológica 9 pacientes, y 1 falleció. La frecuencia de retiro de catéteres peritoneales y muerte no presentó diferencia comparada con las peritonitis por gram negativos (Chi 2 p = 0.63) y gram positivos (Chi 2 p = 0.58). Conclusión: La peritonitis por Acinetobacter es infrecuente en nuestro medio, mostró un perfil de sensibilidad antibiótica favorable y la tasa de curación y complicaciones no difirió con las peritonitis por otros microorganismos.
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