ABSTRACT
Resumen: Introducción: Pacientes sometidos a cirugías cardiotorácicas requieren atención postquirúrgica en la Unidad de Cuidados Intensivos, un inadecuado manejo postquirúrgico incide negativamente en la evolución e incrementa el riesgo de complicaciones orgánicas. Objetivo: Determinar la incidencia de infección de vías respiratorias inferiores e identificación de microorganismos en pacientes postquirúrgicos de cirugía cardiovascular. Material y métodos: Estudio descriptivo, observacional, transversal y retrospectivo, durante el periodo de enero a diciembre de 2017. Resultados: Se revisaron 147 expedientes, donde 47% fueron mujeres y 53% hombres, edad promedio: 53.70 ± 15.70 años. Diagnóstico de ingreso, predominó la estenosis aórtica severa en 29.93% de los casos. La cirugía más realizada fue cambio valvular aórtico (40.82%). Microorganismos aislados: 76.87% de los cultivos fueron negativos; staphylococcus epidermidis sobresalió con 4.76%. La sensibilidad antibiótica fue: nitrofurantoína 26.47%, trimetoprim con sulfametoxazol 11.76, y 8.82% levofloxacino, respectivamente. La evolución de los pacientes, 90.50% fue buen pronóstico; en el caso de las complicaciones, 64.63% no las presentó. Conclusión: La presencia de infecciones respiratorias inferiores y su resistencia antibiótica en pacientes postoperados de cirugía cardiovascular, representa una problemática mundial, y afecta su adecuada evolución debido a la falla de tratamientos en las Áreas de Cuidados Intensivos.
Abstract: Introduction: Patients undergoing cardiothoracic surgery require post-surgical care in the Intensive Care Unit, an inadequate postoperative management has a negative impact on the patient's recovery and increases the probability of presenting organic complications. Objective: To determine the incidence of lower respiratory tract infection and identification of microorganisms in postsurgical patients of cardiovascular surgery. Material and methods: This is a descriptive, observational, transversal and retrospective study. The period covered was from January to December 2017. Results: 147 cases were reviewed, where 47% corresponded to women and 53% to men, with an average age of 53.70 ± 15.70 years. Regarding the diagnosis of admission, severe aortic stenosis predominated, registering 29.93% of the cases. The surgery that was most performed was the aortic valve change (40.82%). Regarding the isolation of microorganisms, 76.87% of the patients were negative or not performed; however, Staphylococcus epidermidis stood out with 4.76%. Of the patients who were positive for isolation, 26.47% were sensitive to nitrofurantoin, 11.76% to trimethoprim with sulfamethoxazole, and 8.82% to fluconazole and levofloxacin, respectively. Regarding the evolution of patients, 90.50% had a good prognosis; in the case of complications, 64.63% did not present any. Conclusion: The presence of lower respiratory infections in patients postoperated by cardiovascular surgery, combined with resistance by administered antibiotics, represents a global problem, and that significantly affects the efficient medical attention due to the failure of treatments in the Intensive Care Areas.
Resumo: Introdução: Pacientes submetidos à cirurgia cardiotorácica necessitam de cuidados pós-cirúrgicos em Unidade de Terapia Intensiva, uma conduta pós-operatória inadequada tem impacto negativo na recuperação do paciente e aumenta a probabilidade de apresentar complicações orgânicas. Objetivo: Determinar a incidência de infecção do trato respiratório inferior e identificação de microrganismos em pacientes pós-cirúrgicos de cirurgia cardiovascular. Material e métodos: Trata-se de um estudo descritivo, observacional, transversal e retrospectivo. O período abrangido foi de janeiro a dezembro de 2017. Resultados: Foram revistos 147 casos, onde 47% correspondiam a mulheres e 53% a homens, com média de idade de 53,70 ± 15,70 anos. Em relação ao diagnóstico de internação, predominou estenose aórtica grave, registrando 29,93% dos casos. A cirurgia mais realizada foi a troca da valva aórtica (40,82%). Em relação ao isolamento de microrganismos, 76,87% dos pacientes foram negativos ou não realizaram; no entanto, Staphylococcus epidermidis destacou-se com 4,76%. Dos pacientes que foram positivos para o isolamento, 26,47% eram sensíveis à nitrofurantoína, 11,76% à trimetoprima com sulfametoxazol e 8,82% ao fluconazol e à levofloxacina, respectivamente. Em relação à evolução dos pacientes, 90,50% tiveram um bom prognóstico; no caso de complicações, 64,63% não apresentaram nenhuma. Conclusão: A presença de infecções respiratórias inferiores em pacientes no pós-operatório de cirurgia cardiovascular, combinada à resistência por antibióticos administrados, representa um problema global e que afeta significativamente o atendimento médico eficiente devido ao insucesso dos tratamentos nas áreas de Terapia Intensiva.
ABSTRACT
From January 2005 to December 2010, we conducted a prospective cohort surveillance study on surgical site infections (SSIs) in five hospitals, all of which were members of the International Nosocomial Infection Control Consortium (INICC) in four cities in Mexico. Data were recorded from hospitalized patients using the methods and definitions of the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) for SSIs. Surgical procedures (SPs) were classified into 11 types according to the ICD-9 criteria. We documented 312 SSIs, associated with 5063 SPs (5.5%; CI, 5.5-6.9). SSI rates per type of SP in these Mexican hospitals compared with the INICC and CDC-NHSN reports, respectively, include: 18.4% for ventricular shunt (vs. 12.9% vs. 5.6%); 10% for spleen surgery (vs. 5.6% vs. 2.3%); 7.3% for cardiac surgery (vs. 5.6% vs. 1.3%); 6.4% for open reduction of fracture (vs. 4.2% vs. 1.7%); 5.2% for exploratory abdominal surgery (vs. 4.1% vs. 2.0%), and 5.1% for hip prosthesis (vs. 2.6% vs. 1.3%). Compared with the CDC-NHSN, our SSIs rates were higher in 73% and similar in 27% of the analyzed types of SPs, whereas compared with INICC, rates were similar in 55% and higher in 45% of SPs. There are no data on SSI rates by surgical procedure in Mexico. Therefore, this paper represents an important advance in the knowledge of epidemiology of SSIs in Mexico that will allow us to introduce targeted interventions. This study also demonstrates that the INICC is a valuable international benchmarking tool, in addition to the CDC-NSHN, the participating hospitals of which enjoy factual advantages.
