Infecciones Oportunistas en Trauma

Trauma is the leading cause of death for the population between 1 and 45 years old. Head injury is the main cause of death followed by hemorrhage. In general, infection is responsible for the 10% of the cause of death of trauma patients but is the cause of 54% of deaths after 48 hours and 76% of deaths after the first week. Human body responds to injury by means of a systemic inflammatory response syndrome (SIRS), followed by CARS (compensatory anti-inflammatory response syndrome) with a marked decrease of inflammatory response and with MARS (mixed anti and inflammatory response syndrome) when this type of response is balanced. Recently, the importance of T cells as a response mediator has been emphasized. Trauma patients can present trauma-related infections (such as soft tissue injuries, open fractures, hollow viscus injuries, pleural drainage tubes associated infections, etc.) and critical care patient associated infections (such as ventilator associated pneumonia, catheter related bacteremia or urinary tract infections). It is very important to be aware of the local predominant flora in the ICU to properly start empiric treatment until microorganisms has been diagnosed. Definition of opportunistic microorganism involves any of them with the ability of growing and producing disease when the patient presents any alteration in his mechanisms of immune defense. Systemic inflammatory response and immune alteration can expose the patient to Candida, Clostridium Difficile, citomegalovirus and herpes simplex associated infections that always must be taken into account for the differential diagnosis. Furthermore, it is essential to establish an institutional infection and antibiotic control program and to develop suitable bundles to emphasize proper infections surveillance and prevention.