Actualización sobre conceptos y estrategias contemporáneas en la infección quirúrgica de la herida: una revisión narrativa.
Resumen
Objetivo: Analizar la evidencia teórica reciente que existe acerca de la fisiopatología, diagnósticos y tratamiento actual en la infección de la herida quirúrgica como complicación postoperatoria. Materiales y métodos: Este artículo se llevó a cabo mediante una revisión narrativa de la literatura científica, se identificaron bases de datos y se definieron términos MeSH y palabras clave de texto libre en la búsqueda de información. Para garantizar la calidad y transparencia de la revisión, se aplicó la Escala SANRA. Resultados: La búsqueda narrativa arrojó una muestra final de 57 artículos que permitieron extraer la información clave para realizar una síntesis narrativa con el fin de construir una comprensión integral y estructurada del tema. La infección quirúrgica de la herida, también conocida como infección del sitio quirúrgico (ISQ) resulta de la interacción entre la virulencia bacteriana y la respuesta inmune del huésped tras el trauma quirúrgico. Su diagnóstico combina criterios clínicos, cultivos microbiológicos e imágenes, siguiendo los lineamientos de los centros para el control y prevención de enfermedades (CDC). El tratamiento requiere un enfoque multidisciplinario, con control de la fuente temprana bajo el uso de antimicrobianos empíricos y luego dirigidos con cultivos y antibiogramas, al igual que el manejo quirúrgico en el caso de infecciones profundas o de órgano. Conclusiones: Es importante conocer la patogénesis, los criterios diagnósticos y los protocolos de tratamiento basados en la evidencia para brindar un manejo adecuado en las infecciones del sitio quirúrgico como complicación postoperatoria.
Descargas
Citas
Pinchera B, Buonomo AR, Moriello NS, Scotto R, Villari R, Gentile I. Update on the Management of Surgical Site Infections. Antibiotics [Internet]. Multidisciplinary Digital Publishing Institute; 2022 Nov 11 [cited 2025 Sep];11(11):1608. Available from: https://doi.org/10.3390/antibiotics11111608
Maraş G, Sürme Y. Surgical Site Infections: Prevalence, Economic Burden, and New Preventive Recommendations. Exploratory Research and Hypothesis in Medicine [Internet]. 2023 Apr 24 [cited 2025 Oct];366. Available from: https://doi.org/10.14218/erhm.2023.00010
Ariza F, Castaño D, Bolaños-Aldana JD, Quintana‐Díaz M. Surgical site infection in adults undergoing major non-cardiac surgery and its association with anemia, severe bleeding and intraoperative transfusion: A preliminary report from a prospective registry. Colombian Journal of Anesthesiology [Internet]. 2020 Sep 7 [cited 2025 Aug];48(4). Available from: https://doi.org/10.5554/22562087.e925
Seidelman J, Anderson DJ. Surgical Site Infections. Infectious Disease Clinics of North America [Internet]. Elsevier BV; 2021 Oct 28 [cited 2025 Sep];35(4):901. Available from: https://doi.org/10.1016/j.idc.2021.07.006
Werra CD, Aloia S, Micco RD, Giudice RD, Tramontano R, Mangani F, et al. SSIs in Italy: Prevention and Surveillance during the Last Five Years. Surgical Science [Internet]. 2015 Jan 1 [cited 2025 Aug];6(8):383. Available from: https://doi.org/10.4236/ss.2015.68056
Sganga G, Baguneid M, Dohmen PM, Giamarellos‐Bourboulis EJ, Romanini E, Vozikis A, et al. Management of superficial and deep surgical site infection: an international multidisciplinary consensus. Updates in Surgery [Internet]. 2021 Mar 26 [cited 2025 Oct];73(4):1315. Available from: https://doi.org/10.1007/s13304-021-01029-z
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas BF, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery [Internet]. 2017 May 3 [cited 2025 Oct];152(8):784. Available from: https://doi.org/10.1001/jamasurg.2017.0904
Solomkin JS, Mazuski JE, Blanchard J, Itani KMF, Ricks P, Dellinger EP, et al. Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infections. Surgical Infections [Internet]. 2017 May 1 [cited 2025 Oct];18(4):385. Available from: https://doi.org/10.1089/sur.2017.075
Bucătaru A, Bălăşoiu M, Ghenea AE, Zlatian O, Vulcănescu DD, Horhat FG, et al. Factors Contributing to Surgical Site Infections: A Comprehensive Systematic Review of Etiology and Risk Factors. Clinics and Practice [Internet]. PAGEPress (Italy); 2023 Dec 28 [cited 2025 Aug];14(1):52. Available from: https://doi.org/10.3390/clinpract14010006
Reichman DE, Greenberg JA. Reducing surgical site infections: a review. PubMed [Internet]. 2009 Jan 1 [cited 2025 Feb];2(4):212. Available from: https://pubmed.ncbi.nlm.nih.gov/20111657
Sganga G, Tascini C, Sozio E, Colizza S. Early recognition of methicillin-resistant Staphylococcus aureus surgical site infections using risk and protective factors identified by a group of Italian surgeons through Delphi method. World Journal of Emergency Surgery [Internet]. BioMed Central; 2017 Jun 12 [cited 2025 Aug];12(1). Available from: https://doi.org/10.1186/s13017-017-0136-3
Kurtuluş İ, Culcu OD, Koçak F, Kesgin V, Değerli MS. El efecto del tipo de traslado del paciente al quirófano sobre la ISQ: inquietudes frente a evidencia. Cirugía y Cirujanos [Internet]. 2022 Nov 2 [cited 2025 Aug];90(6). Available from: https://doi.org/10.24875/ciru.21000873
Sartelli M, Guirao X, Hardcastle TC, Kluger Y, Boermeester MA, Raşa K, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World Journal of Emergency Surgery [Internet]. BioMed Central; 2018 Dec 1 [cited 2025 Aug];13(1). Available from: https://doi.org/10.1186/s13017-018-0219-9
Carranza‐Lira S, Serrano-Estrada FD, López-Muñoz E, Hernández-Jiménez LM, Chavarría-Olarte ME. Concentración de hemoglobina glucosilada en pacientes no diabéticas con y sin infección de sitio quirúrgico posterior a la histerectomía. Cirugía y Cirujanos [Internet]. 2020 May 4 [cited 2025 Aug];88(3). Available from: https://doi.org/10.24875/ciru.19001411
Gaudillière B, Fragiadakis GK, Bruggner RV, Nicolau M, Finck R, Tingle M, et al. Clinical recovery from surgery correlates with single-cell immune signatures. Science Translational Medicine [Internet]. 2014 Sep 24 [cited 2025 Aug];6(255). Available from: https://doi.org/10.1126/scitranslmed.3009701
Margraf A, Ludwig N, Zarbock A, Rossaint J. Systemic Inflammatory Response Syndrome After Surgery: Mechanisms and Protection. Anesthesia & Analgesia [Internet]. Lippincott Williams & Wilkins; 2020 Nov 13 [cited 2025 Oct];131(6):1693. Available from: https://doi.org/10.1213/ane.0000000000005175
Alazawi W, Pirmadjid N, Lahiri R, Bhattacharya S. Inflammatory and Immune Responses to Surgery and Their Clinical Impact. Annals of Surgery [Internet]. Lippincott Williams & Wilkins; 2016 Apr 29 [cited 2025 Aug];264(1):73. Available from: https://doi.org/10.1097/sla.0000000000001691
Snow TAC, Waller AV, Loye R, Ryckaert F, Antonio C, Saleem N, et al. Early dynamic changes to monocytes following major surgery are associated with subsequent infections. Frontiers in Immunology [Internet]. 2024 Apr 9 [cited 2025 Oct];15. Available from: https://doi.org/10.3389/fimmu.2024.1352556
Yu Q, Cen C, Gao M, Yuan H, Liu J. Combination of early Interleukin-6 and -18 levels predicts postoperative nosocomial infection. Frontiers in Endocrinology [Internet]. 2022 Oct 10 [cited 2025 Aug];13. Available from: https://doi.org/10.3389/fendo.2022.1019667
Dąbrowska A, Słotwiński R. The immune response to surgery and infection. Central European Journal of Immunology [Internet]. Termedia Publishing House; 2014 Jan 1 [cited 2025 Sep];4:532. Available from: https://doi.org/10.5114/ceji.2014.47741
Paruk F, Chausse J. Monitoring the post surgery inflammatory host response. Journal of Emergency and Critical Care Medicine [Internet]. 2019 Sep 1 [cited 2025 Jul];3:47. Available from: https://doi.org/10.21037/jeccm.2019.08.06
Li R, Ye JJ, Gan L, Zhang M, Sun D, Li Y, et al. Traumatic inflammatory response: pathophysiological role and clinical value of cytokines. European Journal of Trauma and Emergency Surgery [Internet]. Springer Science+Business Media; 2023 Dec 27 [cited 2025 Aug];50(4):1313. Available from: https://doi.org/10.1007/s00068-023-02388-5
López-Bago A, Reyes REG, Santana JER, Jiménez JR. Inmunidad e inflamación en el proceso quirúrgico. Revista de la Facultad de Medicina (México) [Internet]. 2018 Aug 3 [cited 2025 Jun];61(4):7. Available from: https://www.medigraphic.com/pdfs/facmed/un-2018/un184b.pdf
Madeira MZ de A, Trabasso P. Surgical site infections in women and their association with clinical conditions. Revista da Sociedade Brasileira de Medicina Tropical [Internet]. 2014 Aug 1 [cited 2025 Aug];47(4):457. Available from: https://doi.org/10.1590/0037-8682-0125-2014
Del-Moral-Luque JA, Sánchez-Santana T, Gil-Yonte P, Fernández‐Cebrián JM, Hijas-Gómez AI, Rodríguez‐Caravaca G. Efecto de un Plan de Mejora de Calidad y Seguridad Clínica en la incidencia de infección de sitio quirúrgico en apendicectomía. Estudio cuasi-experimental. Cirugía y Cirujanos [Internet]. 2018 Sep 5 [cited 2025 Aug];86(5). Available from: https://doi.org/10.24875/ciru.18000293
Poveda V de B, Galvão CM, Santos CB dos. Fatores predisponentes à infecção do sítio cirúrgico em gastrectomia. Acta Paulista de Enfermagem [Internet]. 2005 Mar 1 [cited 2025 Jul];18(1):31. Available from: https://doi.org/10.1590/s0103-21002005000100005
Gasperi AD, Merli M, Petrò L, Roselli E. Surgical Site Infections and Antibiotic Prophylaxis in Surgery: Update 2023. In 2024 [cited 2025 Oct]. p. 33. Available from: https://doi.org/10.1007/978-3-031-43891-2_3
Mulder T, Bergh MK van den, Mourik MSM van, Romme J, Crolla RMPH, Bonten MJM, et al. A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery. Infection Control and Hospital Epidemiology [Internet]. 2019 Mar 14 [cited 2025 Aug];40(5):574. Available from: https://doi.org/10.1017/ice.2019.36
Lioce CG, Davis EC, Bennett J, Townsend FI, Bloch CP. Scalpel blade contamination and risk of postoperative surgical site infection following abdominal incisions in dogs. BMC Research Notes [Internet]. 2019 Jul 25 [cited 2025 Aug];12(1). Available from: https://doi.org/10.1186/s13104-019-4494-7
Luca RC, Kostantinos M, Michael B, Capuano N, Mezzoprete R. Fast-resorbable antibiotic-loaded hydrogel coating to reduce postsurgical infection after internal osteosynthesis: A multicenter randomized controlled trial. Revue de Chirurgie Orthopédique et Traumatologique [Internet]. 2017 Oct 18 [cited 2025 Aug];103(7). Available from: https://doi.org/10.1016/j.rcot.2017.09.102
Molla M, Anteneh KT, Seyoum T, Melkamu M. Surgical site infection and associated factors among women underwent cesarean delivery in Debretabor General Hospital, Northwest Ethiopia: hospital based cross sectional study. BMC Pregnancy and Childbirth [Internet]. 2019 Aug 29 [cited 2025 Aug];19(1). Available from: https://doi.org/10.1186/s12884-019-2442-0
Jentzsch T, Kutschke L, Zingg PO, Farshad M. Operating room architecture is not a risk factor for surgical site infections. Scientific Reports [Internet]. 2021 Jun 28 [cited 2025 Aug];11(1). Available from: https://doi.org/10.1038/s41598-021-90574-z
Alnajjar MS, Alashker DA. Surgical site infections following caesarean sections at Emirati teaching hospital: Incidence and implicated factors. Scientific Reports [Internet]. 2020 Oct 30 [cited 2025 Aug];10(1). Available from: https://doi.org/10.1038/s41598-020-75582-9
Naeem W, Salem AM, Mohamed AM, Sakr B. Incidence of Post Cesarean Section Infection in Emergency Unit of Gynecology and Obstetrics in Benha University Hospital. Benha Medical Journal [Internet]. 2024 Nov 29 [cited 2025 Jul];0. Available from: https://doi.org/10.21608/bmfj.2024.327378.2226
Henriksen NA, Meyhoff CS, Wetterslev J, Jørgensen T, Rasmussen LS, Jørgensen LN. Clinical relevance of surgical site infection as defined by the criteria of the Centers for Disease Control and Prevention. Journal of Hospital Infection [Internet]. 2010 Mar 25 [cited 2025 Aug];75(3):173. Available from: https://doi.org/10.1016/j.jhin.2009.12.022
Copanitsanou P, Santy‐Tomlinson J. The nurses’ role in the diagnosis and surveillance of orthopaedic surgical site infections. International Journal of Orthopaedic and Trauma Nursing [Internet]. 2020 Aug 27 [cited 2025 Aug];41:100818. Available from: https://doi.org/10.1016/j.ijotn.2020.100818
Cohen N, Bock JM, May AK. Sepsis and postoperative surgical site infections. Surgery [Internet]. 2023 Feb 10 [cited 2025 Oct];174(2):403. Available from: https://doi.org/10.1016/j.surg.2023.01.006
Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu‐Zidan FM, Abbas A, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World Journal of Emergency Surgery [Internet]. BioMed Central; 2021 Sep 25 [cited 2025 Oct];16(1). Available from: https://doi.org/10.1186/s13017-021-00387-8
Sartelli M, Coccolini F, Abu‐Zidan FM, Ansaloni L, Bartoli S, Biffl W, et al. Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections! World Journal of Emergency Surgery [Internet]. 2020 Apr 19 [cited 2025 Aug];15(1). Available from: https://doi.org/10.1186/s13017-020-00308-1
Alsharari AZM, Alruwaili WMA, Saba HEM, Alanazi NMR, Alkhaldi ABM, Alruwaili MMM, et al. Diagnosis and Management of Surgical Site Infections: Narrative Review. Journal of Pharmaceutical Research International [Internet]. 2021 Dec 11 [cited 2025 Apr];65. Available from: https://doi.org/10.9734/jpri/2021/v33i54b33766
Rizzo CE, Venuto R, Tripodi P, Bartucciotto L, Spagnolo EV, Nirta A, et al. From Guidelines to Action: Tackling Risk Factors for Surgical Site Infections. Antibiotics [Internet]. 2025 Jan 6 [cited 2025 Aug];14(1):40. Available from: https://doi.org/10.3390/antibiotics14010040
Rodríguez‐Caravaca G, Gutiérrez-Baz M, Benito-Fernández L de, Rodríguez-Villar D, Vicente-Jiménez S, Gil-Conesa M, et al. Efecto de la adecuación de la profilaxis antibiótica en la incidencia de infección de sitio qruirúrgico en la cirugía vascular periférica. Cirugía y Cirujanos [Internet]. 2021 Sep 9 [cited 2025 Mar];89(5). Available from: https://doi.org/10.24875/ciru.20000838
Toro MD del, Arias‐Díaz J, Balibrea JM, Benito N, Canut A, Esteve E, et al. Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery. Enfermedades Infecciosas y Microbiología Clínica [Internet]. 2020 Jul 21 [cited 2025 Aug];39(1):29. Available from: https://doi.org/10.1016/j.eimc.2020.02.017
Urbina T, Razazi K, Ourghanlian C, Woerther P, Chosidow O, Lepeule R, et al. Antibiotics in Necrotizing Soft Tissue Infections. Antibiotics [Internet]. Multidisciplinary Digital Publishing Institute; 2021 Sep 13 [cited 2025 Oct];10(9):1104. Available from: https://doi.org/10.3390/antibiotics10091104
Goh TC, Bajuri MY, Nadarajah SC, Rashid AHA, Baharuddin S bt, Zamri KS. Clinical and bacteriological profile of diabetic foot infections in a tertiary care. Journal of Foot and Ankle Research [Internet]. 2020 Jan 1 [cited 2025 Jul];13(1). Available from: https://doi.org/10.1186/s13047-020-00406-y
Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Maternal Health Neonatology and Perinatology [Internet]. BioMed Central; 2017 Jun 13 [cited 2025 Aug];3(1). Available from: https://doi.org/10.1186/s40748-017-0051-3
Hermosillo-Cornejo DG, Rodríguez-Reyes E, Álvarez-Hernández DA, Athié-Athié A de J, Garza PAM, Correa-Rovelo JM. Análisis del cumplimiento de profilaxis antibiótica en colecistectomía laparoscópica electiva en un hospital de México. Cirujano General [Internet]. 2020 Jan 1 [cited 2025 Jan];42(4):274. Available from: https://doi.org/10.35366/101396
Dhole S, Mahakalkar C, Kshirsagar S, Bhargava A. Antibiotic Prophylaxis in Surgery: Current Insights and Future Directions for Surgical Site Infection Prevention. Cureus [Internet]. Cureus, Inc.; 2023 Oct 28 [cited 2025 Oct]; Available from: https://doi.org/10.7759/cureus.47858
Zejnullahu VA, Isjanovska R, Sejfija Z, Zejnullahu VA. Surgical site infections after cesarean sections at the University Clinical Center of Kosovo: rates, microbiological profile and risk factors. BMC Infectious Diseases [Internet]. 2019 Aug 28 [cited 2025 Aug];19(1). Available from: https://doi.org/10.1186/s12879-019-4383-7
Barbarewicz F, Henkel K, Dudde F. Diagnosis and management of postoperative wound infections in the head and neck region. Oncoscience [Internet]. 2023 Oct 4 [cited 2025 Aug];10:56. Available from: https://doi.org/10.18632/oncoscience.589
García-Valenzuela SE, Bonilla-Catalán PV, Quintero-García B, Trujillo-Bracamontes FS, Ríos-Beltrán J del C, Sánchez-Cuén JA, et al. Abdomen agudo quirúrgico. Un reto diagnóstico. Cirujano General [Internet]. 2017 Jan 1 [cited 2025 Aug];39(4):203. Available from: https://doi.org/10.35366/77686
Vu NV, Nazari MA, Dang T, Muralev Y, Mohanraj M, Tran T, et al. Type of the Paper: Article. 2025 Jan 1 [cited 2025 Sep]; Available from: https://doi.org/10.2139/ssrn.5384374
Sánchez-Escobedo Y, León-Morales MI, Ramírez-Vega R. Importancia de la antibioticoterapia ante colecciones intraabdominales complicadas en pacientes con lesión renal aguda: reporte de casos. Cirujano General [Internet]. 2020 Jan 1 [cited 2025 Jan];42(4):300. Available from: https://doi.org/10.35366/101399
Javed H, Olanrewaju OA, Owusu F, Saleem A, Pavani P, Tariq H, et al. Challenges and Solutions in Postoperative Complications: A Narrative Review in General Surgery. Cureus [Internet]. Cureus, Inc.; 2023 Dec 22 [cited 2025 Aug]; Available from: https://doi.org/10.7759/cureus.50942
Guo K, Gong W, Zheng T, Hong Z, Wu X, Ren H, et al. Clinical parameters and outcomes of necrotizing soft tissue infections secondary to gastrointestinal fistulas. BMC Infectious Diseases [Internet]. 2019 Jul 9 [cited 2025 Aug];19(1). Available from: https://doi.org/10.1186/s12879-019-4248-0
Badía JM, Rubio‐Pérez I, Vázquez AM, Membrilla E, Ruíz-Tóvar J, Muñoz-Casares C, et al. Surgical Site Infection Prevention Measures in General Surgery: Position Statement by the Surgical Infections Division of the Spanish Association of Surgery. Cirugía Española (English Edition) [Internet]. 2020 Apr 1 [cited 2025 Oct];98(4):187. Available from: https://doi.org/10.1016/j.cireng.2020.04.001
Thabit AK, Fairaq EM, Almutairi F. Appropriateness of choice and duration of surgical antibiotic prophylaxis and the incidence of surgical site infections: A prospective study. Journal of Taibah University Medical Sciences [Internet]. 2022 Sep 16 [cited 2025 Sep];18(1):26. Available from: https://doi.org/10.1016/j.jtumed.2022.08.012
Derechos de autor 2026 Carlos Daniel Pérez Campo , Shadia Nadime Esper Socarrás, Andrea Quintero Taboada
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
.png)
.png)
1.png)
