Profilaxis Antibiótica en el Politraumatizado. Guías 2011 elaboradas por los comités de Infectología Crítica y de Trauma de la Sociedad Argentina de Terapia Intensiva (SATI)
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Resumen
OBJETIVO:Elaborar guías de profilaxis antibiótica (P-ATB) en politraumatizados.
MATERIALES Y MÉTODOS: Sistema GRADE para calidad y fuerza de la evidencia.RESULTADOS:1)P-ATB prequirúrgica, debridamiento amplio:1-A.2)Trauma abdomen sin lesión de víscera hueca, con/sin packing:2-D; con lesión de víscera hueca, con/sin packing, P-ATB hasta 24 hs del posoperatorio 1-A.3)Trauma de cráneo: a)colocación de sensor de PIC:2-D; b)fractura base cráneo: no P-ATB 1-A; c)fractura hundimiento, por arma de fuego, con/sin atricción de partes blandas (P-ATB no previene meningitis, absceso) 2-D. 4)Trauma maxilofacial: a)cerrado: con/sin hemoseno, no P-ATB 1-A; b)penetrante (ruptura de senos, pérdida de piezas dentarias, con/sin laceración de mucosa):P-ATB por 1-día 1-A; c)fractura mandibular: reducción cerrada/abierta: P-ATB posoperatorio 2-D; d)cara sin fractura, lesión de partes blandas:2-D; e)trauma ocular penetrante: P-ATB durante 1-día 2-D. 5)Quemados: a)prevenir sepsis temprana e infección de herida 1-C; b)quemados graves,de alto riesgo,en ARM: prevención de neumonía e infecciones nosocomiales: 2-B; c)quemadura <40%: curación simple, balneoterapia y resecciones de escaras 1-C;d)procedimientos en quemaduras >40%, P-ATB perioperatoria para reducir bacteriemia perioperatoria e infección de la quemadura: 2-C; e)prevenir pérdida de injertos de piel autóloga 2-C. 6)Trauma tórax: a)colocación de drenaje: 2-D; b)aspiración de contenido gástrico: no P-ATB 1-A.7) Trauma pelvis-genitourinario abiertas a vagina/recto y lesión víscera hueca: P-ATB hasta 24 hs del posoperatorio 1-A. 8)Fractura expuesta huesos largos: a)iniciar P-ATB rápidamente 1-A; b)Gustillo I-II:suspender ATB 24 hs luego del cierre de heridas 1-B; c)Gustillo III: continuar ATB por 72 hs luego del trauma y 24 hs posterior al cierre de heridas 1-B. CONCLUSIONES: Pocas indicaciones con fuerte nivel de evidencia para P-ATB
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