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Secuencia temporal de patógenos bacterianos y fúngicos que causan infecciones en pacientes con trauma
Frederique J C van Eerten1, Miquel B Ekkelenkamp2, Joost D J Plate3
1Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Trauma surgery & acute care open
|August 27, 2025
Resumen
Las infecciones en pacientes con trauma muestran una secuencia de patógenos, cambiando de microbios comunes a los adquiridos en el hospital con el tiempo. Este patrón sugiere que el desequilibrio inmune prolongado contribuye a las infecciones semanas después de una lesión grave.
Área de la Ciencia:
- Enfermedades infecciosas
- Cirugía de traumas
- Inmunología
Sus antecedentes:
- Los pacientes de la Unidad de Cuidados Intensivos (UCI) con inmunidad comprometida son susceptibles a infecciones causadas por patógenos.
- Los pacientes con lesiones graves pueden experimentar un deterioro inmunológico similar, prolongando el riesgo de infección.
- Los patógenos adquiridos en el hospital, seleccionados por antibióticos, pueden causar infecciones en estos pacientes vulnerables.
Objetivo del estudio:
- Para investigar el momento de las infecciones en pacientes con lesiones graves.
- Para identificar el espectro de patógenos que causan infecciones en diferentes momentos después del trauma.
Principales métodos:
- Estudio de cohorte retrospectivo en un centro de trauma de nivel 1 (2013-2022).
- Incluidos los pacientes con lesiones graves con estadía en UCI > 48 horas.
- Infecciones documentadas (criterios de los CDC) y patógenos causantes, observando el tiempo en días posteriores al trauma.
Principales resultados:
- 109/572 pacientes con lesiones graves desarrollaron complicaciones infecciosas.
- Se observó una secuencia temporal distinta de patógenos.
- Las infecciones tempranas (antes del día 40) se relacionaron con *Staphylococcus aureus*, *Enterococcus* spp. y CoNS; las infecciones posteriores (después del día 60) involucraron *Klebsiella* spp., *Candida* spp., *Enterobacter* spp. y *Pseudomonas* spp.
Conclusiones:
- Los pacientes con lesiones graves exhiben una secuencia temporal de patógenos causantes de infecciones.
- Los microorganismos comensales predominan inicialmente, cambiando a patógenos adquiridos en el hospital con el tiempo.
- Esta secuencia apoya la hipótesis de que un desequilibrio sostenido en el sistema inmune innato facilita las infecciones de aparición tardía.
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