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Microbiología de secreciones bronquiales en una unidad de cuidados intensivos
Resumen
Objetivos: conocer los patrones locales de resistencia a antibióticos de las bacterias aisladas de secreciones bronquiales en una unidad de cuidados intensivos, y evaluar los casos de neumonía asociada a ventilador.
Material y métodos: análisis retrospectivo de los patrones de resistencia a antibióticos, durante 2004 y 2005. Para calcular el número de casos de neumonía asociada a ventilador se estableció diagnóstico consensuado entre un equipo de vigilancia local comparándolo con el informe del área de epidemiología hospitalaria.
Resultados: las bacterias más aisladas fueron Pseudomonas aeruginosa con 134 aislamientos (26 %), 71 multidrogorresistentes (53 %); seguida por Staphylococcus con 122 aislamientos (24 %), de los cuales 88 correspondieron a S. aureus, con 62 aislados (70 %) resistentes a meticilina. Las enterobacterias, Eschericha coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, así como Acinetobacter sp. y Stenotrophomonas maltophilia se aislaron ocasionalmente. Candida representó 17 %. Se identificaron tres periodos en los que el aislamiento de Staphylococcus aureus fue mayor y tres para P. aeruginosa. Hubo diferencias entre los casos de neumonía asociada a ventilador informados por epidemiología hospitalaria y el equipo de vigilancia local.
Conclusiones: destaca la alta frecuencia de resistencia en P. aeruginosa y S. aureus. Las enterobacterias, Acinetobacter o S. maltophilia no representaron un problema. Por la divergencia en los casos informados de neumonía asociada a ventilador deben establecerse definiciones claras de caso.
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