Sepsis en unidad de cuidados intensivos neonatales
DOI:
https://doi.org/10.31790/inspilip.v8i26.661Palabras clave:
Sepsis neonatal, Unidades de Cuidados Intensivos Neonatales, Mortaidad, MultirresistenciaResumen
Introducción: La sepsis neonatal, es una de las principales causas de mortalidad en recién nacidos prematuros a nivel mundial, la infección puede ser adquirida durante el embarazo, parto o durante su ingreso hospitalario en unidad de cuidados intensivos neonatales. Objetivos: Realizar una revisión sistemática sobre sepsis en unidad de cuidados intensivos neonatales. Materiales y métodos: Se elaboró una revisión de la literatura, seleccionando 62 artículos médicos, obtenidos de bases de datos como National Library of Medicine, Pubmed, Elsevier, Europe PMC, X-MOL, National Certification corporation y revistas como: Nature, BMJ, JAMA, New England Journald of Medicine y las guías sobreviviendo a la sepsis; se utilizaron artículos médicos de los últimos 5 años. Resultados: la mortalidad de la sepsis aumenta considerablemente con la aparición de gérmenes resistentes a los antibióticos. Se observa baja susceptibilidad a los esquemas convencionales utilizados en sepsis neonatal tardía y buena respuesta a meropenen. La candidiasis invasiva fue la infección por hongo más frecuente. La profilaxis antibiótica intraparto no disminuye el riesgo de sepsis neonatal. El tiempo de esquema terapéutico corto de 10 días no es inferior a esquemas de 14 días. En los casos de falta de respuesta al tratamiento se debe escalar el esquema antibiótico y antimicótico. Conclusión: La sepsis neonatal, es una de las principales causas de morbilidad y mortalidad en recién nacidos prematuros a nivel mundial. Se debe tener especial cuidado en el control prenatal con las infecciones del tracto genitourinario y evitar ruptura prematura de membranas con ascenso bacteriano complicado con corioamnionitis, considerando, además, que la administración de antibióticos intraparto, no ha demostrado disminuir la mortalidad de la sepsis neonatal. El empleo de penicilina más gentamicina, es uno de los mejores esquemas, con menos efectos sobre resistencia y traslocación bacteriana pero cuando se trata de resistencia bacteriana, el mejor esquema terapéutico se realiza con meropenen. En cuanto a sepsis por candidiasis invasiva (germen más frecuente), el tratamiento con caspofungina demostró tasas más altas de supervivencia en comparación con anfotericina B. Los microorganismos con mayor resistencia bacteriana fueron: Klebsiella pneumoniae, E. coli, Acinetobacter baumannii, E. cloacae, Burkholderia cepacia y Pseudomonas aeruginosa.
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