Neumonía intrahospitalaria postquirúrgica y factores de riesgo, en pacientes adultos de 40 a 80 años, estudio a realizarse en el Hospital Abel Gilbert Pontón período 2011-2015
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
Resumen
La neumonía nosocomial es la infección nosocomial bacteriana más común en las unidades de cuidados intensivos médicos y quirúrgicos (UCI). El desarrollo de esta enfermedad aumenta considerablemente el costo de atención y la duración de la estancia hospitalaria. Los pacientes desarrollan fiebre y leucocitosis, que son requisito primordial para el diagnóstico presuntivo de la enfermedad. Representa la causa más común de muerte entre todas las infecciones adquiridas en el hospital, con tasas de mortalidad de hasta el 33%. Es común en los individuos sometidos a ventilación mecánica, pero también puede desarrollarse en pacientes no ventilados. El propósito de esta investigación es determinar los factores de riesgo de neumonía intrahospitalaria postquirúrgica en pacientes del Hospital Abel Gilbert Pontón durante el periodo del 2011 al 2015, mediante la revisión de historias clínicas para disminuir su morbimortalidad. El presente estudio fue de tipo analítico, retrospectivo de corte transversal. Se analizó todos los pacientes que tuvieron intervenciones quirúrgicas en el Hospital Abel Gilbert Pontón entre el 1 de enero del 2011 hasta el 31 de diciembre del 2015. La mayor cantidad de pacientes con neumonía nosocomial postquirúrgica fue en el año 2011 con el 25% (25), especialmente en mayor proporción de procedencia de la provincia del Guayas (75%), siendo el sexo masculino el predominante (67%). La edad media fue de 33,8 años, donde el grupo de 40-60 años (48%) fue el más frecuente. La mayor cantidad de pacientes pertenecían a la especialidad de Cirugía General, siendo el diagnóstico de ingreso más común el Cáncer de estómago (29%). El procedimiento del Billroth II fue la cirugía más realizada. La estancia hospitalaria promedio fue de 17,3 días, hubieron 67 (67%) pacientes que ingresaron en la Unidad de Cuidados Intensivos, siendo el promedio de días de internación de 7,4 días y el índice de mortalidad fue del 7% (7), en su gran mayoría por falla multiorgánica (43%). El 67% (67) y el 28% (28) del total de pacientes evaluados presentaron factores de riesgo y comorbilidades asociadas respectivamente. El 100% tuvo de los pacientes tenía antecedentes de sondaje vesical y de drenaje de secreciones respectivamente como los principales factores de riesgo presentes. Las comorbilidades principales fueron la hipertensión arterial (32%) y la disfunción tiroidea (21%). Las complicaciones se presentaron en una frecuencia del 21%, siendo la más común la falla multiorgánica (48%).
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Se encontró asociación estadísticamente significativa entre las complicaciones y los factores de riesgo (p 0,001). También se encontró asociación estadísticamente significativa entre la mortalidad y el sexo (p 0,047) y entre la mortalidad y la edad (p 0,031). El agente infeccioso más común fue el bacteriano (44%), seguido en menor frecuencia por infecciones por hongos (3%). Existió un porcentaje considerable de pacientes (53%) que no se aisló microorganismos debido a muestras insuficientes, no realización de cultivos y ausencia de registro de laboratorio de los resultados de cultivos. El 39% presentó infección por Pseudomona auriginosa, que representa la infección nosocomial más común en la muestra de estudio.
Nosocomial pneumonia is the most common bacterial nosocomial infection in units of medical and surgical intensive care unit (ICU). The development of this disease considerably increases the cost of care and length of hospital stay. Patients develop fever and leukocytosis, which are essential for the presumptive diagnosis of the disease condition. It represents the most common cause of death among all hospital-acquired infections, with mortality rates of up to 33%. It is common in individuals undergoing mechanical ventilation, but can also develop in non-ventilated patients. The purpose of this research is to determine the risk factors of nosocomial pneumonia in patients postsurgical Abel Gilbert Ponton Hospital during the period from 2011 to 2015, by reviewing medical records to reduce morbidity and mortality. This study was analytical, cross-sectional retrospective. all patients who had surgery at the Hospital Abel Gilbert Ponton between January 1, 2011 until December 31, 2015 was analyzed. Most post-surgical patients with nosocomial pneumonia was in 2011 with 25% (25), especially in larger proportion of provenance of the province of Guayas (75%), the male predominant (67%). The mean age was 33.8 years, where the group of 40-60 years (48%) was the most frequent. Most patients belonged to the specialty of General Surgery, being the most common diagnosis of stomach cancer income (29%). The procedure Billroth II was the most performed surgery. The average hospital stay was 17.3 days, there were 67 (67%) patients admitted to the Intensive Care Unit, being the average number of days of hospitalization of 7.4 days and the mortality rate was 7% (7), mostly from multiorgan failure (43%). 67% (67) and 28% (28) of the patients evaluated presented risk factors and comorbidities associated respectively. 100% of patients had a history of bladder catheterization and drainage of secretions respectively as the main factors risk present. The main comorbidities were hypertension (32%) and thyroid dysfunction (21%). Complications occurred at a frequency of 21%, being the most common multiple organ failure (48%). VII Statistically significant association between complications and risk factors (p 0.001) was found. Statistically significant association between mortality and sex (p 0.047) and between mortality and age (p 0.031) was also found. The most common bacterial infectious agent was (44%), followed by less frequently fungal infections (3%). There was a considerable percentage of patients (53%) was isolated microorganisms not due to insufficient samples, no crops cultivation and no record of laboratory culture results. 39% showed infection by Pseudomonas auriginosa, which represents the most common nosocomial infection in the study sample.
Nosocomial pneumonia is the most common bacterial nosocomial infection in units of medical and surgical intensive care unit (ICU). The development of this disease considerably increases the cost of care and length of hospital stay. Patients develop fever and leukocytosis, which are essential for the presumptive diagnosis of the disease condition. It represents the most common cause of death among all hospital-acquired infections, with mortality rates of up to 33%. It is common in individuals undergoing mechanical ventilation, but can also develop in non-ventilated patients. The purpose of this research is to determine the risk factors of nosocomial pneumonia in patients postsurgical Abel Gilbert Ponton Hospital during the period from 2011 to 2015, by reviewing medical records to reduce morbidity and mortality. This study was analytical, cross-sectional retrospective. all patients who had surgery at the Hospital Abel Gilbert Ponton between January 1, 2011 until December 31, 2015 was analyzed. Most post-surgical patients with nosocomial pneumonia was in 2011 with 25% (25), especially in larger proportion of provenance of the province of Guayas (75%), the male predominant (67%). The mean age was 33.8 years, where the group of 40-60 years (48%) was the most frequent. Most patients belonged to the specialty of General Surgery, being the most common diagnosis of stomach cancer income (29%). The procedure Billroth II was the most performed surgery. The average hospital stay was 17.3 days, there were 67 (67%) patients admitted to the Intensive Care Unit, being the average number of days of hospitalization of 7.4 days and the mortality rate was 7% (7), mostly from multiorgan failure (43%). 67% (67) and 28% (28) of the patients evaluated presented risk factors and comorbidities associated respectively. 100% of patients had a history of bladder catheterization and drainage of secretions respectively as the main factors risk present. The main comorbidities were hypertension (32%) and thyroid dysfunction (21%). Complications occurred at a frequency of 21%, being the most common multiple organ failure (48%). VII Statistically significant association between complications and risk factors (p 0.001) was found. Statistically significant association between mortality and sex (p 0.047) and between mortality and age (p 0.031) was also found. The most common bacterial infectious agent was (44%), followed by less frequently fungal infections (3%). There was a considerable percentage of patients (53%) was isolated microorganisms not due to insufficient samples, no crops cultivation and no record of laboratory culture results. 39% showed infection by Pseudomonas auriginosa, which represents the most common nosocomial infection in the study sample.
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Infección hospitalaria, Neumonía, Postoperatorio, Epidemiología analítica, Estudios retrospectivos, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador, Adulto, Anciano