Antibioticoterapia para o tratamento de periotonite em diálise peritoneal: redicão sostemática de estudo clínicos controlados e série de casos

• Ano de defesa: 2015
• Autor(a) principal: Pinotti, Douglas Gonçalves [UNESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual Paulista (Unesp)
• Palavras-chave em Português: Dialise peritoneal; Peritonite - Revisão; Microbiologia médica; Meta-analises; Medical microbiology
• Link de acesso: http://hdl.handle.net/11449/131879; http://www.athena.biblioteca.unesp.br/exlibris/bd/cathedra/05-11-2015/000849323.pdf

The choice of antimicrobials for treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing two methodologies, the systematic review with meta-analysis of randomized clinical trials (RCT) and the proportional meta-analysis of cases series, a new strategy that has been used in other clinical settings. Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (1) case series and RCTs with the number of reported patients in each study greater than five, (2) use of any antibiotic therapy for initial treatment of PD-related peritonitis (e.g., cefazolin plus gentamicin, vancomycin plus gentamicin), for gram-positive (e.g., vancomycin, first generation cephalosporin), or for gram-negative rods (e.g., gentamicin, ceftazidime, fluoroquinolone), and (3) studies specifying the rates of resolution. For RCT analyses the outcomes resolution, primary response, catheter removal, and relapse were considered, whilefor proportional meta-analysis only the outcome resolution rate was taken using a random-effects model, and the pooled resolution rates were calculated. Results: 64 studies (21 RCT and 43 case series) met all inclusion criteria. There were 21 comparisons between the antibiotics using in RCT. No superior antimicrobial class or associations were identified, when used for empirical treatment or for gram-positive or gram-negative episodes. Among the case series the pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled propor = ...