|Domingo, octubre 26, 2014

Gérmenes más Frecuentemente Aislados en Infección Urinaria (IU)  

En resumen, los manejos a corto plazo (menores de 3 días) no han demostrado ser mejores que los de 7 días, pero un mínimo necesario no ha sido demostrado todavía.

A juicio del panel de expertos, aquellos con un curso de enfermedad leve pueden ser susceptibles de manejo ambulatorio durante 7 (siete) días, hasta que se decidirá si continuar con profilaxis.

Aquellos con cuadros clínicos más severos, en quien es más probable e implícito la existencia de una forma más intensa de pielonefritis, serán susceptibles de manejo intravenoso inicial durante los tres primeros días, para continuar la consolidación durante 14 (catorce) días, momento en que se decidirá si se continua profilaxis (Algoritmo 1).

1. La probabilidad de IU dado este escenario es de 4 %- 8% (Evidencia IV) Cualquier alternativa puede ser empleada para solicitar el uro-análisis; Urocultivo exclusivamente mediante PSP o CTU. Evitar CTU en prepucio fimótico o sospecha de Cardiopatía Congénita. (Evidencia III, IV)

2. Se considera Uroanálisis Positivo cualquier hallazgo anormal en uno o más de los siguientes ítems: Cualquier Leucocitarias, cualquier título de nitritos, cualquier bacteria en muestra teñida o no, cinco o más leucocitos/campo de alto poder, diez o más leucocitos/mm3. (Evidencia III,IV)

Tratamiento Parenteral (Evidencia II-IV, recomerdación B y D)

 Infección Urinaria Tratamiento Parenteral

Tratamiento Oral o de Consolidación (Evidencia II-IV, recomerdación B y D)

Infección Urinaria Tratamiento Oral o de Consolidación

La evidencia existentes es muy pobre; Se reportan series de casos tratados con ceftriaxona I.M. ambulatoria. (Evidencia V).

Desaparición de la fiebre, adecuada hidratación, tolerancia vía oral, actividad y reactividad.

El valor predictivo positivo (VPP) inferior, corresponde a Urocultivos tomados por CTU, el superior lo es a los tomados por medio de PSP.

(Evidencia III,IV).

Lo más pronto posible significa, tan pronto exista defervescencia y desaparación de los

Anormal como asociado a signos directos o indirectos de obstrucción aguda del flujo urinario. (Evidencia III, IV)

Anormal como asociado a signos indirectos de obstrucción del flujo urinario, anomalías anatómicas, o reflujo vésicouretral. (Evidencia III, IV)

Terapia profiláctica. (Evidencia III-IV, recomendación B)

Terapia profiláctica

El papel que la Gamagrafía Renal DMSA ocupa en el episodio agudo de IU no es claro; su resultado no modifica práctica clínica en la terapia inicial (Evidencia VI)

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Diagnóstico de Infección Urinaria Hemorragia Intraventricular

 

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