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Palabras clave

Palabras claves
politrauma
quemaduras
profilaxis
antibióticos
fracturas expuestas
infecciones

Cómo citar

1.
Reina R. 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). Rev Arg de Ter Int. [Internet]. 17 de noviembre de 2011 [citado 25 de julio de 2024];28(4). Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/285

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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CD004884.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">24.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Stoikes, N.F., et al., <em style="mso-bidi-font-style: normal;">Impact of intracranial pressure monitor prophylaxis on central nervous system infections and bacterial multi-drug resistance.</em> Surg Infect (Larchmt), 2008. <strong style="mso-bidi-font-weight: normal;">9</strong>(5): p. 503-8.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">25.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Kyzas, P.A., <em style="mso-bidi-font-style: normal;">Use of antibiotics in the treatment of mandible fractures: a systematic review.</em> J Oral Maxillofac Surg, 2011. <strong style="mso-bidi-font-weight: normal;">69</strong>(4): p. 1129-45.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">26.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Andreasen, J.O., et al., <em style="mso-bidi-font-style: normal;">A systematic review of prophylactic antibiotics in the surgical treatment of maxillofacial fractures.</em> J Oral Maxillofac Surg, 2006. <strong style="mso-bidi-font-weight: normal;">64</strong>(11): p. 1664-8.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">27.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Soheilian, M., et al., <em style="mso-bidi-font-style: normal;">Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2.</em> Arch Ophthalmol, 2007. <strong style="mso-bidi-font-weight: normal;">125</strong>(4): p. 460-5.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">28.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Durtschi, M.B., et al., <em style="mso-bidi-font-style: normal;">A prospective study of prophylactic penicillin in acutely burned hospitalized patients.</em> J Trauma, 1982. <strong style="mso-bidi-font-weight: normal;">22</strong>(1): p. 11-4.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">29.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>de La Cal, M.A., et al., <em style="mso-bidi-font-style: normal;">Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract: a randomized, placebo-controlled, double-blind trial.</em> Ann Surg, 2005. <strong style="mso-bidi-font-weight: normal;">241</strong>(3): p. 424-30.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">30.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Vindenes, H. and R. Bjerknes, <em style="mso-bidi-font-style: normal;">The frequency of bacteremia and fungemia following wound cleaning and excision in patients with large burns.</em> J Trauma, 1993. <strong style="mso-bidi-font-weight: normal;">35</strong>(5): p. 742-9.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">31.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Steer, J.A., et al., <em style="mso-bidi-font-style: normal;">Randomized placebo-controlled trial of teicoplanin in the antibiotic prophylaxis of infection following manipulation of burn wounds.</em> Br J Surg, 1997. <strong style="mso-bidi-font-weight: normal;">84</strong>(6): p. 848-53.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">32.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Mozingo, D.W., et al., <em style="mso-bidi-font-style: normal;">Incidence of bacteremia after burn wound manipulation in the early postburn period.</em> J Trauma, 1997. <strong style="mso-bidi-font-weight: normal;">42</strong>(6): p. 1006-10; discussion 1010-1.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">33.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Alexander, J.W., et al., <em style="mso-bidi-font-style: normal;">Prophylactic antibiotics as an adjunct for skin grafting in clean reconstructive surgery following burn injury.</em> J Trauma, 1982. <strong style="mso-bidi-font-weight: normal;">22</strong>(8): p. 687-90.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">34.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Ramos, G., et al., <em style="mso-bidi-font-style: normal;">Systemic perioperative antibiotic prophylaxis may improve skin autograft survival in patients with acute burns.</em> J Burn Care Res, 2008. <strong style="mso-bidi-font-weight: normal;">29</strong>(6): p. 917-23.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">35.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Maxwell, R.A., et al., <em style="mso-bidi-font-style: normal;">Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia--a multi-center trial.</em> J Trauma, 2004. <strong style="mso-bidi-font-weight: normal;">57</strong>(4): p. 742-8; discussion 748-9.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">36.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Sanabria, A., et al., <em style="mso-bidi-font-style: normal;">Prophylactic antibiotics in chest trauma: a meta-analysis of high-quality studies.</em> World J Surg, 2006. <strong style="mso-bidi-font-weight: normal;">30</strong>(10): p. 1843-7.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">37.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Bochicchio, G.V., et al., <em style="mso-bidi-font-style: normal;">Impact of nosocomial infections in trauma: does age make a difference?</em> J Trauma, 2001. <strong style="mso-bidi-font-weight: normal;">50</strong>(4): p. 612-7; discussion 617-9.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">38.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Durham, R.M., et al., <em style="mso-bidi-font-style: normal;">Multiple organ failure in trauma patients.</em> J Trauma, 2003. <strong style="mso-bidi-font-weight: normal;">55</strong>(4): p. 608-16.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">39.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Antonelli, M., et al., <em style="mso-bidi-font-style: normal;">Risk factors for early onset pneumonia in trauma patients.</em> Chest, 1994. <strong style="mso-bidi-font-weight: normal;">105</strong>(1): p. 224-8.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">40.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Osborn, T.M., et al., <em style="mso-bidi-font-style: normal;">Epidemiology of sepsis in patients with traumatic injury.</em> Crit Care Med, 2004. <strong style="mso-bidi-font-weight: normal;">32</strong>(11): p. 2234-40.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">41.<span style="mso-tab-count: 1;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><em style="mso-bidi-font-style: normal;">The eastern association for the surgery of trauma </em>2010; Available from: <a href="http://www.east.org/tpg/gueval.pdf"><span style="color: #0000ff;">http://www.east.org/tpg/gueval.pdf</span></a>.</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: -36pt; margin: 0cm 0cm 0pt 36pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-no-proof: yes;" lang="EN-US">&nbsp;</span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; margin: 0cm 0cm 0pt;"><span style="line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US">&nbsp;</span></p>

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