Evidencia científica de la duración del tratamiento antibiótico en las infecciones intraabdominales con control de foco quirúrgico / Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control

El aumento progresivo de las resistencias antibióticas apremia el tener estrategias para disminuir la presión sobre la microbiota. La duración del tratamiento antibiótico empírico es variable, a pesar de las recomendaciones de las guías. Se ha realizado una revisión bibliográfica de la evidencia científica publicada sobre la duración del tratamiento antibiótico empírico en las infecciones intraabdominales quirúrgicas con control de foco efectivo. Se analizan las guías americanas realizadas por Mazuski et al. de 2017 como eje central en las recomendaciones de la duración de tratamiento antibiótico empírico en infecciones intraabdominales con control del foco y se añade una búsqueda bibliográfica de todos los artículos que contuviesen las palabras claves en Pubmed y Google Scholar. Se recopilan 21 artículos referentes en la duración del tratamiento antibiótico empírico en la infección intraabdominal con control del foco. Con las guías americanas y estos artículos se ha elaborado una propuesta de duración del tratamiento antibiótico empírico en pacientes sin factores de riesgo entre 24 y 72 h. Y en los que presentan factores de riesgo se habría de individualizar el mismo con monitorización activa cada 24 h de fiebre, íleo paralítico y leucocitosis, ante una detección precoz de complicaciones o de necesidad de cambios en el espectro antibiótico. Los tratamientos cortos son igual de eficaces que los de duraciones más prolongadas y se asocian a menos tasa de efectos adversos, por tanto, ajustar y revaluar diariamente la duración del tratamiento antibiótico empírico es fundamental para una mejor praxis (AU)

A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 2017, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72h. And in those who present risk factors, it should be individualized with active monitoring every 24h of fever, paralytic ileus and leukocytosis, before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice (AU)

Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control.

A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections (IIA) with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 20171, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72 h. And in those who present risk factors, it should be individualized with active monitoring every 24 h of fever, paralytic ileus and leukocytosis (FIL), before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice.

Estudio del valor predictivo de la revisión primaria y de las exploraciones complementarias para anticipar la necesidad de intervención quirúrgica en pacientes con heridas de arma blanca en el torso / A study of the predictive value of the primary review and complementary examinations in assessing the need for surgery in patients with stab wounds in the torso

Introducción La observación es el patrón oro del tratamiento de heridas de arma blanca en pacientes estables. El objetivo del estudio fue analizar el valor de la exploración física inicial y de las exploraciones complementarias ante la necesidad de cirugía, para disminuir tiempos de observación. Material y métodos Estudio retrospectivo de un registro prospectivo de pacientes politraumáticos, seleccionando heridas de arma blanca troncales. Se analizan parámetros clínicos y diagnósticos. La variable principal es la necesidad de cirugía. Resultados Entre 2006 y 2009 se incluyó a 198 pacientes, con injury severity score medio de 7,8 ± 7 y mortalidad del 0,5%. El 52% sufrieron heridas múltiples que se distribuyeron en cervicales 23%, torácicas 46% y abdominales 31%. Precisaron intervención quirúrgica 73 pacientes (37%), siendo el 59% inmediata, 27% precoz y 14% tardía. La necesidad de intervención se asoció a un menor revised trauma score, evisceración, hemorragia activa o constatación de herida penetrante. Las hemoglobinas iniciales, a las 2 y 12 h fueron significativamente inferiores en pacientes quirúrgicos. La tomografía computarizada (TC) positiva se asoció a intervención. Un 18% de pacientes presentaron complicaciones, concentradas en los pacientes quirúrgicos. Las intervenciones tardías no presentaron más complicaciones que las inmediatas (p = 0,72). El 10% de los pacientes con exploración física y complementarias normales precisaron cirugía y el 6% desarrollaron complicaciones. Conclusión Ningún parámetro fisiológico o analítico guía de forma individual la necesidad de intervención. La exploración física seriada es la maniobra diagnóstica más importante para decidir intervención, pero la TC puede usarse de forma liberal. Una observación de 24 h es recomendable en pacientes con heridas penetrantes (AU)

Introduction Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. Methods A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery. Results A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8 ± 7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. Conclusion None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds (AU)

[A study of the predictive value of the primary review and complementary examinations in assessing the need for surgery in patients with stab wounds in the torso]. / Estudio del valor predictivo de la revisión primaria y de las exploraciones complementarias para anticipar la necesidad de intervención quirúrgica en pacientes con heridas de arma blanca en el torso.

INTRODUCTION: Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. METHODS: A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery. RESULTS: A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8±7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. CONCLUSION: None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds.