DIAGNOSTICO DE INFECCION DE SITIO QUIRRIGICO.pptx

INFECCION DE SITIO QUIRURGICO

1. DIAGNÓSTICO DE LAS INFECCIONES DE SITIO QUIRURGICO

2. DIAGNÓSTICO DE LAS INFECCIONES DE SITIO QUIRURGICO La sola observación de material purulento o eritema en la herida quirúrgica por el cirujano suele ser suficiente para el diagnóstico de infecciones quirúrgicas; sin embargo, en ocasiones el reconocimiento oportuno representa un reto mayor.

3. MARCADORES DE DIAGNOSTICO Quizá el marcador utilizado con mayor frecuencia para el diagnóstico de infecciones quirúrgicas sea la serie blanca en la biometría hemática, siendo su principal inconveniente la baja sensibilidad descrita para algunos procedimientos. Es el caso de neurocirugías donde es inferior a 50%

4. PROTEINA C REACTIVA Es un reactante de fase aguda clásico con síntesis en especial hepática, en respuesta al daño tisular o a procesos infecciosos , previa estimulación de los hepatocitos por las citocinas. Algunos estudios señalan que puede ser un buen marcador, accesible y de menor precio comparativo con otros biomarcadores, aunque sus niveles pueden verse afectados, en especial durante la primera semana posoperatoria.

5. PROCALCITONINA La procalcitonina (PCT) es una proteína muy estable. La cinética de elevación es muy rápida: detectándose en el suero a las 6 a 12 h, tras un estímulo infeccioso. Alcanza su máxima concentración a las 12 a 16 h Normalizándose tras la curación de la infección casi de manera inmediata. Los niveles permanecerán elevados mientras no se resuelva el proceso infeccioso lo que resulta ser útil en el seguimiento de los pacientes. Se ha informado sensibilidad de 83%, especificidad de 62%, para detectar ISQ pos-apendicetomías

6. ESTUDIOS DE IMAGEN En ocasiones el diagnóstico, localización asertiva y caracterización de la ISQ permanece como un reto clínico, donde los estudios de imagen tienen un papel fundamental.

7. ULTRASONIDO El ultrasonido tiene la ventaja de su facilidad de realización, ser inocuo Se utiliza en especial para la detección de colecciones abdominales. ESPECIFICIDAD: 71 a 92% SENSIBILIDAD: 87 a 99% Desventajas: Su capacidad diagnóstica es técnico-dependiente tiene escasa sensibilidad en la detección de abscesos pequeños y aquellos situados en el retroperitoneo.

8. TOMOGRAFIA AXIAL COMPUTARIZADA Tiende a ser la técnica de elección, debido a su mayor resolución anatómica y mejor definición de colecciones. ESPECIFICIDAD: 95 a 97% SENSIBILIDAD: 94 a 95% Desventajas: se encuentra la disponibilidad necesidad de traslado del paciente

9. PREVENCIÓN DE INFECCIONES QUIRÚRGICAS Los pacientes programados para una intervención quirúrgica deben ser vigilados para minimizar el riesgo de ISQ. Antes de la cirugía, se debe tratar y resolver cualquier infección coexistente. Los pacientes fumadores deben dejarlo durante 1 o 2 meses antes de la cirugía programada Control glucémico con en pacientes con DM2 El control glucémico en el perioperatorio reduce las ISQ, con un umbral de glucosa < 200 mg/dl.

10. Recomendaciones del Personal Medico Las fuentes de los microorganismos son aire, paciente y miembros del equipo quirúrgico. El número de organismos que se depositan en una herida depende de su extensión y del tiempo que permanece expuesta, del número de organismos en el aire y del patrón de flujo del mismo.

11. Profilaxis Antibióticos Los antibióticos prequirúrgicos deben administrarse en los 60 min previos a la incisión de la piel para alcanzar la concentración terapéutica en el suero y los tejidos durante el procedimiento quirúrgico. La vancomicina y las fluoroquinolonas deben iniciarse antes, ya que sus tiempos de infusión y semividas son más prolongados. La administración de los antibióticos tiene que repetirse si la duración de la cirugía supera las dos semividas de los fármacos o si hay una pérdida masiva de sangre.

12. Tratamiento de la infección de sitio Quirúrgico Las heridas quirúrgicas infectadas deben abrirse para permitir que la infección drene, y se considerará el desbridamiento si hay tejido desvitalizado o infectado. Cuando haya signos de infección sistémica, como fiebre > 38,5 °C, taquicardia > 110 latidos/min y leucocitosis > 12.000/µl, o cuando haya celulitis (cuyo eritema se extiende > 5 cm desde el borde de la herida).

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