Résumé
RESUMEN Fundamento: los procesos infecciosos son una de las causas de morbilidad y mortalidad en pacientes quemados, por lo que el diagnóstico temprano de la infección a través del estudio bacteriológico cuantitativo representa un paso de avance para el tratamiento oportuno. Objetivo: determinar mediante el estudio bacteriológico cuantitativo de la herida por quemadura el diagnóstico de infección en pacientes quemados. Métodos: se realizó un estudio descriptivo, de corte transversal para determinar mediante el estudio bacteriológico cuantitativo de la herida por quemadura el diagnóstico de infección en los pacientes quemados ingresados en el servicio de Caumatología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey, desde septiembre de 2015 a noviembre de 2017. Se estudiaron 34 pacientes y se evaluaron las variables: edad, sexo, índice de gravedad, positividad o no de los estudios cualitativos y cuantitativos en relación con las manifestaciones clínicas de infección. Resultados: el sexo femenino fue el más representado con 70,59 % de casos, predominaron las edades entre 48-67 años, el 38,23 % de los lesionados estaban clasificados como muy grave, la colonización fue la predominante sobre la infección en el cultivo cuantitativo con un 26,47 %. En los pacientes con manifestaciones clínicas de infección, el cultivo bacteriológico cuantitativo fue positivo en 11 de ellos para un 32,35 %. Se encontró en el 44,12 % la presencia de gérmenes a una concentración de más de 105 gérmenes por gramo de tejido. Conclusiones: los factores determinantes en la aparición de infección en la herida por quemadura son la edad, la extensión y profundidad de las lesiones. Existió una correlación entre la positividad del estudio bacteriológico cuantitativo y la presencia de manifestaciones clínicas de infección en los pacientes. Se documentó mayor número de cultivos cuantitativos con resultados positivos y su correlación con la presencia de gérmenes en los cultivos cualitativos.
ABSTRACT Background: the infectious processes are one of the main causes of morbidity and mortality in the burned patients, which is why the early diagnosis of the infection through the bacteriological quantitative study represents a forward-motion step for the opportune treatment of these patients. Objective: to determine the diagnosis of infection in the burned patients by means of the bacteriological quantitative study of the injury by burn. Methods: a descriptive, cross-section study was carried out to determine by means of the bacteriological quantitative study of the injury by burn the diagnosis of infection in the burned patients entered in the service of Burn at Manuel Ascunce Domenech Universitary Hospital of the province Camagüey, from September 2015 to November 2017. 34 patients were studied in those who were evaluated the following variables: age, sex, severity rate, positivity or no of the qualitative and quantitative study relating to the clinical public demonstrations of infection. Results: in this study the feminine sex became represented by 70.59 %, predominating ages between 48- 67 years, the 38.23 % of injured persons were classified as very grave, and colonization was the predominant on the infection in the quantitative cultivation with a 26.47 %. In patients with clinical demonstrations of infection, the quantitative culture was positive in 11 of them for a 32.35 %. It was found in 44.12 % of patients, the presence from germs to a concentration of over 105 germen per gram of fabric. Conclusions: determining factors in the appearing of infection in the injury by burn were age, extension and depth of the injuries. There was a correlation between the positivity of the bacteriological quantitative study and the presence of clinical demonstrations of infection in these patients. Greater number of quantitative cultivations with positive results and their correlation with the presence of germs in the qualitative cultivations were documented.
Résumé
Introdução: A infecção de pele é a complicação mais comum no paciente queimado. O padrão-ouro para o seu diagnóstico é a biópsia de pele, porém o método mais utilizado nos centros de queimados é o swab. Objetivo: Comparar os resultados obtidos pela cultura entre a biópsia e o swab daescara, para o diagnóstico de infecção de pele nos pacientes internados na Unidade de Tratamento de Queimados do HPS de Porto Alegre; além disso, determinou-se a taxa de infecção das escaras e identificaram-se os tipos de germes encontrados nas culturas. Método: Realizou-se um estudo clínico prospectivo entre junho e outubro de 2007, em que foi realizada a coleta de swab e biópsia de pele em 25 pacientes, entre a primeira e a terceira semanas de internação. Resultados: Foram coletados 74 exames (37 swabs e 37 biópsias). A sensibilidade do swab foi de 100% e sua especificidade de 77,4%. Vinte por cento dos pacientes apresentaram infecção de pele, sendo o germe mais encontrado nas culturas (26,6%) o S. aureus. Conclusão: O swab, quando fornegativo, é um excelente exame para excluir a hipótese de infecção de pele.
Introduction: Burn wound infection is the most common type of complication in burn patients. The gold standard for its diagnosis is a biopsy, but the most utilized method in the burn centers is the swab. Objective: The main goal of this study is to compare the results obtained through biopsy and swab when diagnosing burn wound infection amongst patients admitted in the Burn Unit of HPS - Porto Alegre. Also, it is an objective to determine the rateof burn wound infection and to identify the different types of germs found in these cultures. Method: A prospective clinical study was performed from June to October 2007. Throughout that period, swabs and biopsies were taken in 25 patients during the first, and/or second, and/ or third week of admission in the facility. Results: A total of 74 exams were performed (37 swabs and 37 biopsies). The sensibility of the swab was 100%, and its specificity was 77.4%. 20% of the patients presented burn wound infection and the most common germ found in the cultures (26.6%) was S. aureus. Conclusion: When the swab presents a negative result, we have an excellent exam to exclude the possibility of burn wound infection.