Infecciones intraabdominales en adultos causadas por Streptococcus pneumoniae: reporte de 18 casos

INTRODUCTION: Streptococcus pneumoniae ( Spn ) is occasionally implicated as a cause of intra-abdominal infection (IIA Spn ) 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 IIA Spn describing: clinical presentation, comorbidities, need for surgery, microbiological findings, therapeutic behavior, and evolution. METHODS: study of 18 adult patients with IIA Spn . Clinical and microbiological characteristics and evolution of infections were analyzed. RESULTS: IIA Spn 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 tuboovarian abscess) and had a favorable evolution. In the intraoperative samples, pure culture of Spn sensitive to penicillin was isolated. Two of three 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. CONCLUSIONS: IIA Spn 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.