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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2006, Número 6

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Rev Invest Clin 2006; 58 (6)


Sepsis por Staphylococcus aureus resistente a meticilina: la sombra de una amenaza permanente

Sifuentes-Osornio J, Pérez-Patrigeon S

Idioma: Español
Referencias bibliográficas: 50
Paginas: 598-607
Archivo PDF: 176.23 Kb.


RESUMEN

Caso clínico. Este hombre de 27 años ingresó por pancreatitis aguda grave (PAG) postalcohólica y desarrolló sepsis (bacteriemia y neumonía de focos múltiples) por Staphylococcus aureus resistente a meticilina (SARM); requirió ventilación mecánica y hemodiálisis y presentó además fungemia por Candida albicans resistente a fluconazol. Fue manejado con vancomicina por seis semanas y caspofungina por 20 días y egresó a los 51 días por mejoría. Este caso muestra la dolorosa evolución de un paciente internado en una unidad de terapia intensiva (UTI) con sepsis por SARM. De acuerdo con el estudio nacional de infecciones nosocomiales en EUA, S. aureus representa hasta 35% de las neumonías y bacteriemias nosocomiales. Utilizando técnicas de genotipificación molecular (ej. Campos pulsados) se han descrito varias familias de MRSA. El uso de catéteres IV, hospitalización prolongada, cirugía y uso previo de antimicrobianos son los principales factores de riesgo para SARM. En México, Alpuche-Aranda (1986) reportó una prevalencia de SARM de 5% en un hospital pediátrico. Sin embargo, recientemente, la Red Nacional de Resistencia informó una prevalencia de 36% en el 2004. En el Instituto, encontramos una prevalencia SARM de 100% en la UTI durante 2005. Este caso muestra un paciente con SAG postalcohol complicado con infecciones graves como sepsis por SARM y candidemia; afortunadamente, con un tratamiento multidisciplinario y agresivo, tuvo un desenlace favorable. Este paciente presentaba todos los factores de riesgo para SARM, en un ambiente con prevalencia elevada de resistencia a meticilina. Este hallazgo debería motivar a la comunidad médica para diseñar estrategias adecuadas y eficaces de control epidemiológico.


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