Profilaxis antibiótica en el manejo conservador de los pacientes con trauma renal: ¿Aún existe controversia?

Resumen

Objetivo Describir la evidencia que existe en la actualidad acerca del uso del antibiótico profiláctico en el manejo conservador del trauma renal.

Material y métodos Decidimos realizar una revisión de la literatura para intentar resolver la controversia existente acerca de la efectividad del uso de antibiótico profiláctico en pacientes con trauma renal para prevenir complicaciones infecciosas.

Resultados El trauma renal es un problema importante en los servicios de urgencias en el mundo. La mayoría corresponden a traumatismos cerrados y principalmente a accidentes de tránsito, aunque pueden ser secundarios a un trauma penetrante. Los abscesos perirrenales son poco frecuentes, se estima que ocurren en menos del 1% de todos los casos de trauma renal y en aproximadamente 5% de los casos de trauma renal penetrante. Dada la baja incidencia de abscesos perirrenales y las diferentes corrientes existe controversia para el tratamiento antibiótico. El manejo es conservador en la mayoría de los casos, y depende del grado de la lesión, el compromiso vascular y el estado hemodinámico del paciente.

Conclusión Aún no existe claridad acerca de la utilización de antibiótico profiláctico en el manejo conservador del paciente con un traumatismo renal, relacionado con el tipo de trauma y el grado de la lesión. Sugerimos el uso de antibiótico profiláctico en pacientes con trauma penetrante grado IV dada la mezcla de ambiente externo, cuerpo extraño y orina, sin embargo, no hay evidencia de alta calidad al respecto.

Abstract

Objective To describe the current evidence on the use of the prophylactic antibiotic in the conservative management of renal trauma.

Materials and Methods We decided to review the general and updated literature to try to solve the controversy about the effectiveness of the use of antibiotic prophylaxis in patients with renal trauma to prevent infectious complications.

Results Renal trauma is an important trauma in emergency services around the world. Most of them are blunt and mainly because of transit accidents, although they could be due to penetrating trauma. Perirenal abscesses are uncommon, it is estimated that occur in less than 1% of all cases of renal trauma and ∼5% of cases of penetrating renal trauma. Given the low incidence of perirenal abscesses and different streams, controversy exists for antibiotic treatment. Conservative management is the preferred choice, normally according to the grade of the trauma, the vascular compromise and the patient́s hemodynamic response.

Conclusion There is still no consensus about the use of prophylaxis antibiotics in conservative management of patients with renal trauma, related to type and the grade of trauma. We suggest the use of a prophylactic antibiotic in patients with grade IV penetrating trauma given the mixture of external environment, foreign body and urine, however there is no evidence of high quality on this regard.

Palabras Clave

heridas y lesiones - lesiones abdominales - riñón - profilaxis antibiótica

Keywords

wounds and injury - abdominal injuries - kidney - wounds - antibiotic prophylaxis

Contribuciones de los autores

Los autores arriba mencionados, declaran que han contribuido de manera significativa en la concepción, construcción, finalización y aprobación del manuscrito final para ser enviado a Urología Colombiana.

Declaración de conflicto de intereses

Los autores arriba mencionados, declaran que no tienen conflicto de ningún tipo relacionado con la elaboración de este artículo. No hay nada que declarar.

• Referencias

• 1 Patel P. Management of renal injuries in blunt abdominal trauma. Duttaroy D. , editor. J Res Med Dent Sci. 2014;2(2):38–42
• 2 Lumen N, Kuehhas FE, Djakovic N. , y col. Review of the current management of lower urinary tract injuries by the EAU Trauma Guidelines Panel. Eur Urol 2015; 67 (05) 925-929
• 3 Santucci RA, Wessells H, Bartsch G. , y col. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int 2004; 93 (07) 937-954
• 4 Makanjuola JK, Grange PCR, Kooiman G, Brown C, Sharma DM. Centralisation of major trauma: an opportunity for acute urology services in the UK. BJU Int 2012; 109 (02) 173-174
• 5 Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H. ; American Association for the Surgery of Trauma. American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries. J Trauma 2006; 60 (02) 351-356
• 6 Santucci RA, McAninch JW, Safir M, Mario LA, Service S, Segal MR. Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2001; 50 (02) 195-200
• 7 Moore EE, Shackford SR, Pachter HL. , y col. Organ injury scaling: spleen, liver, and kidney. J Trauma 1989; 29 (12) 1664-1666
• 8 Shoobridge JJ, Corcoran NM, Martin KA, Koukounaras J, Royce PL, Bultitude MF. Contemporary management of renal trauma. Rev Urol 2011; 13 (02) 65-72
• 9 Shariat SF, Trinh Q-D, Morey AF. , y col. Development of a highly accurate nomogram for prediction of the need for exploration in patients with renal trauma. J Trauma 2008; 64 (06) 1451-1458
• 10 Heyns CF. Renal trauma: indications for imaging and surgical exploration. BJU Int 2004; 93 (08) 1165-1170
• 11 McCombie SP, Thyer I, Corcoran NM. , y col. The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand. BJU Int 2014; 114 (Suppl. 01) 13-21
• 12 Yang C-S, Chen IC-J, Wang C-Y, Liu C-C, Shih H-C, Huang M-S. Predictive indications of operation and mortality following renal trauma. J Chin Med Assoc 2012; 75 (01) 21-24
• 13 van der Wilden GM, Velmahos GC, Joseph DK. , y col; GM van der W. Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the research consortium of New England Centers for Trauma. JAMA Surg 2013; 148 (10) 924-931
• 14 Long J-A, Fiard G, Descotes J-L. , y col. High-grade renal injury: non-operative management of urinary extravasation and prediction of long-term outcomes. BJU Int 2013; 111 (4 Pt B): E249-E255
• 15 Dobrowolski Z, Kusionowicz J, Drewniak T. , y col. Renal and ureteric trauma: diagnosis and management in Poland. BJU Int 2002; 89 (07) 748-751
• 16 Moudouni SM, Patard JJ, Manunta A, Guiraud P, Guille F, Lobel B. A conservative approach to major blunt renal lacerations with urinary extravasation and devitalized renal segments. BJU Int 2001; 87 (04) 290-294
• 17 García HA, Urrea MF, Serna A, Aluma LJ. Experiencia clínica en el manejo del traumatismo renal en el Hospital Universitario del Valle (Cali, Colombia). Actas Urol Esp 2009; 33 (08) 881-887
• 18 Kansas BT, Eddy MJ, Mydlo JH, Uzzo RG. Incidence and management of penetrating renal trauma in patients with multiorgan injury: extended experience at an inner city trauma center. J Urol 2004; 172 (4 Pt 1): 1355-1360
• 19 Wilson RF, Ziegler DW. Diagnostic and treatment problems in renal injuries. Am Surg 1987; 53 (07) 399-402
• 20 Husmann DA, Gilling PJ, Perry MO, Morris JS, Boone TB. Major renal lacerations with a devitalized fragment following blunt abdominal trauma: a comparison between nonoperative (expectant) versus surgical management. J Urol 1993; 150 (06) 1774-1777
• 21 Rosen MA, McAninch JW. Management of combined renal and pancreatic trauma. J Urol 1994; 152 (01) 22-25
• 22 McGuire J, Bultitude MF, Davis P, Koukounaras J, Royce PL, Corcoran NM. Predictors of outcome for blunt high grade renal injury treated with conservative intent. J Urol 2011; 185 (01) 187-191
• 23 Broghammer JA, Fisher MB, Santucci RA. Conservative management of renal trauma: a review. Urology 2007; 70 (04) 623-629
• 24 da Costa IA, Amend B, Stenzl A, Bedke J. Contemporary management of acute kidney trauma. J Acute Dis 2015; 5 (01) 29-36