Sirgo Gonzalo, Bodí Maria, Díaz Emili, Rello Jordi
Critical Care Department, University Hospital 12 Octubre, Madrid, Spain.
Semin Respir Crit Care Med. 2002 Oct;23(5):435-41. doi: 10.1055/s-2002-35714.
Trauma is the leading cause of death in young people. Trauma deaths have a classic trimodal distribution; in late death (3 days to 3 weeks postinjury), infection is the principal cause. Because pneumonia is a major cause of morbidity in trauma patients, early identification of subjects at a high risk of developing nosocomial pneumonia (NP) can reduce morbidity and costs. Methicillin-sensitive Staphylococcus aureus (MSSA) is the predominant pathogen in multiple-trauma patients in coma, and nasal MSSA colonization at time of severe injury may increase the risk of MSSA pneumonia. In the remaining patients, gram-negative bacilli are responsible for the majority of cases. Prolonged mechanical ventilation, continuous enteral feeding, and craniotomy are risk factors for NP in trauma patients. Diagnosis of NP in these patients is difficult because radiographic infiltrates may not highlight any infection. In coma patients, coverage with a beta-lactam active against MSSA is mandatory. Variations in organisms and sensitivities across intensive care units due to differences in demographic characteristics or comorbidities should be considered.
创伤是年轻人死亡的主要原因。创伤死亡呈现典型的三峰分布；在晚期死亡（受伤后3天至3周）中，感染是主要原因。由于肺炎是创伤患者发病的主要原因，早期识别有发生医院获得性肺炎（NP）高风险的患者可降低发病率和成本。甲氧西林敏感金黄色葡萄球菌（MSSA）是昏迷的多发伤患者中的主要病原体，严重受伤时鼻腔MSSA定植可能增加MSSA肺炎的风险。在其余患者中，革兰氏阴性杆菌是大多数病例的病因。长时间机械通气、持续肠内喂养和开颅手术是创伤患者发生NP的危险因素。这些患者的NP诊断困难，因为影像学浸润可能无法凸显任何感染。对于昏迷患者，必须使用对MSSA有效的β-内酰胺类药物进行覆盖。应考虑由于人口统计学特征或合并症差异导致的各重症监护病房中病原体和敏感性的变化。
