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La infección respiratoria en el paciente ventilado puede desarrollarse a partir de microorganismos procedentes tanto de fuentes endógenas como exógenas. La mayoría de ellas tiene un origen endógeno y se relaciona con la broncoaspiración de material colonizado procedente de la orofaringe. Pero existe un porcentaje no despreciable de infecciones respiratorias debidas a microorganismos procedentes del entorno del paciente, particularmente patógenos multirresistentes como Staphylococcus aureus resistentes a meticilina (SARM), Acinetobacter baumannii, Pseudomonas aeruginosa multirresistentes, por Legionella spp. u hongos filamentosos, particularmente Aspergillus. Este artículo revisa la patogénesis de la infección respiratoria en el paciente intubado y la importancia del entorno, animado e inanimado, como fuente de transmisión de microorganismos.
Palabras clave:
Neumonía asociada a ventilación
Patogénesis
Entorno
Respiratory infections in intubated patients can derive from endogenous or exogenous sources. The major route for acquiring endemic ventilator-associated pneumonia (VAP) is oropharyngeal colonization by endogenous flora and leakage of contaminated secretions into the lower respiratory tract. However, a not inconsiderable percentage of VAP results from exogenous nosocomial colonization, especially pneumonias caused by resistant bacteria such as methicillin-resistant Staphylococcus aureus and multiresistant Acinetobacter baumannii or Pseudomonas aeruginosa, as well as by Legionella spp or filamentous fungi, such as Aspergillus. This article reviews the pathogenesis of VAP and the role of the intensive care environment as a source of pathogenic microorganisms.
Key words:
Ventilator-associated pneumonia
Pathogenesis
Environment
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