Rosa María Girón Moreno

Achromobacter xylosoxidans infection in an adult cystic fibrosis unit in Madrid

BACKGROUND Achromobacter xylosoxidans is an emerging pathogen in cystic fibrosis (CF). Although the rate of colonization by this microorganism is variable, prevalence is increasing in CF units. METHODS A microbiological/clinical study was conducted on of adult CF patients harboring A. xylosoxidans. Identification and susceptibility testing were performed using MicroScan (Siemens). Decline in lung function was assessed using the variable, annual percentage loss of FEV1 (forced expiratory volume in 1s). RESULTS A. xylosoxidans was isolated in 18 (19.8%) of 91 patients over a 14-year period. Mean age was 26.6 years (18-39 years). Nine patients (9.8%) were chronically colonized. Piperacillin/tazobactam and imipenem were the most active antibiotics. Mean annual decline in lung function in chronically colonized patients was 2.49%. CONCLUSIONS A. xylosoxidans is a major pathogen in CF. A decreased lung function was observed among patients who were chronically colonized by A. xylosoxidans. Antibiotic therapy should be started early in order to prevent chronic colonization by this microorganism.

Ventilación mecánica no invasiva en una población anciana que ingresa en una unidad de monitorización respiratoria: causas, complicaciones y evolución al año de seguimiento

OBJECTIVE To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and 1 year later in comparison with the results from the younger age group (<75). MATERIAL AND METHODS Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH<7.35 and PaCO(2)>45 mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24 h), complications and evolution at the 1-year follow-up. RESULTS Mean age of the sample was 80.6. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the 1-year follow-up was 63.21%. CONCLUSIONS NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV.

Trastornos psicológicos y calidad de vida en pacientes con bronquiectasias no relacionadas con fibrosis quística

INTRODUCTION Patients with chronic bronchiectasis (BQ) may suffer from psychological disorders. The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit, using validated questionnaires. PATIENTS AND METHODS We included patients consecutively diagnosed with BQ (unrelated to cystic fibrosis) by high resolution computed tomography in the study. Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory, State-Trait Anxiety Inventory and St. Georges Respiratory Questionnaire, after signing the informed consent. They were classified according to their scores on the psychological screening questionnaires, and their results were compared with the clinical, radiological and functional parameters and Quality of Life. RESULTS Seventy patients were included, 48 women and 22 men, with a mean age of 64.19years. Thirty-four percent (34%) of patients showed symptoms of depression, and around 55% had scores above the 50th percentile in trait and state anxiety. The amount of sputum was associated with trait anxiety. Bacterial colonization was related to anxiety (trait and state), especially Pseudomonas aeruginosa colonization. Female patients showed a higher risk of depression. There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression. CONCLUSIONS A high percentage of patients with BQ presented anxiety (trait and state) and depression. The daily sputum production and bacterial colonization (especially with P. aeruginosa) were the variables most related to anxiety; depression was more common in women. We believe that the presence of psychological disorders should be evaluated, especially in patients with this profile.

Localización mediante arpón de nódulos pulmonares para su resección por cirugía videotoracoscópica

Objetivo Valorar la utilidad de la tecnica de colocacion de arpones guiada con tomografia computarizada para la localizacion de nodulos pulmonares y su posterior reseccion mediante cirugia por videotoracoscopia asistida. Describir el proceso y sus complicaciones Pacientes Y Metodos Se han localizado nueve nodulos pulmonares en 9 pacientes, todos menores o iguales a 2 cm de diametro, de caracter radiologico indeterminado y sin diagnostico etiologico. Cuatro pacientes contaban con antecedentes de cancer. Los nodulos se localizaron mediante una aguja con arpon modelo Kopans, guiada mediante tomografia computarizada y se resecaron por videotoracoscopia Resultados El arpon se coloco correctamente en ocho de los pacientes y de forma incorrecta en uno de ellos. En un enfermo fue preciso ampliar a toracotomia. El diagnostico histologico de los nueve nodulos fue de benignidad: hamartoma en cinco casos, nodulo necrotico o fibrotico en dos, granuloma en uno y ganglio antracotico en uno. El tiempo de estancia hospitalaria oscilo entre uno y 8 dias con una media de 3,3 dias Conclusione La localizacion de nodulos pulmonares mediante aguja con arpon para su posterior reseccion por videotoracoscopia asistida es un metodo sencillo y seguro que facilita al cirujano la extirpacion de los mismos, en determinadas ocasiones, para su diagnostico y tratamiento

Antibioterapia inhalada en la fibrosis quística

Resumen La fibrosis quistica es la enfermedad genetica letal mas frecuente en la poblacion caucasiana. La infeccion bronquial cronica, especialmente por Pseudomonas aeruginosa, es la principal causa de morbimortalidad de esta patologia. El tratamiento antibiotico por aerosol alcanza altas concentraciones en la via aerea con baja toxicidad, por lo que permite el empleo cronico. En la actualidad hay 2 antibioticos aprobados para su uso inhalatorio, la tobramicina en solucion para inhalacion y el colistimetato de sodio, existiendo con este ultimo menos evidencias en estudios clinicos. La indicacion fundamental es la colonizacion bronquial cronica por P. aeruginosa, aunque cada vez se demuestra mas relevancia en la primoinfeccion por esta bacteria, acompanada o no de antibioticos por via oral o intravenosos. Mas controvertido es el uso de la aerosolterapia antibiotica en la profilaxis bacteriana o en la exacerbacion respiratoria. Durante muchos anos se han estado empleando formulaciones intravenosas de distintos antibioticos en aerosol, las cuales estan en distintas fases de investigacion para su lanzamiento como presentacion por via nebulizada. Ademas de su indicacion en el tratamiento de la infeccion por P. aeruginosa se han empleado otros antibioticos en aerosol para otros patogenos como Staphylococus aureus resistentes a meticilina , Mycobacterium abscessus o Aspergillus fumigatus .Cystic fibrosis is the most frequent fatal genetically-transmitted disease among Caucasians. Chronic bronchial infection, especially by Pseudomonas aeruginosa, is the main cause of morbidity and mortality in this disease. Aerosolized antibiotic therapy achieves high drug concentrations in the airway with low toxicity, allowing chronic use. Currently, two antibiotics have been approved for inhalation therapy, tobramycin inhalation solution and colistimethate sodium aerosol. There is less evidence from clinical trials for the latter. The main indication for these drugs is chronic bronchial colonization by P. aeruginosa, although there is increasing evidence of the importance of the primary infection by this bacterium, whether treated by oral or intravenous antibiotics or not. More controversial is the use of aerosolized antibiotic therapy in bacterial prophylaxis or respiratory exacerbations. For many years, intravenous formulations of distinct antibiotics for aerosolized use have been employed, which are in distinct phases of research for use in nebulizer therapy. In addition to being used to treat P. aeruginosa infection, aerosolized antibiotics have been used to treat other pathogens such as methicillin-resistant Staphylococus aureus, Mycobacterium abscessus and Aspergillus fumigatus.: Cystic fibrosis is the most frequent fatal genetically-transmitted disease among Caucasians. Chronic bronchial infection, especially by Pseudomonas aeruginosa, is the main cause of morbidity and mortality in this disease. Aerosolized antibiotic therapy achieves high drug concentrations in the airway with low toxicity, allowing chronic use. Currently, two antibiotics have been approved for inhalation therapy, tobramycin inhalation solution and colistimethate sodium aerosol. There is less evidence from clinical trials for the latter. The main indication for these drugs is chronic bronchial colonization by P. aeruginosa, although there is increasing evidence of the importance of the primary infection by this bacterium, whether treated by oral or intravenous antibiotics or not. More controversial is the use of aerosolized antibiotic therapy in bacterial prophylaxis or respiratory exacerbations. For many years, intravenous formulations of distinct antibiotics for aerosolized use have been employed, which are in distinct phases of research for use in nebulizer therapy. In addition to being used to treat P. aeruginosa infection, aerosolized antibiotics have been used to treat other pathogens such as methicillin-resistant Staphylococus aureus, Mycobacterium abscessus and Aspergillus fumigatus.

Experience with Aerosolized Imipenem in Patients with Cystic Fibrosis and Achromobacter xylosoxidans

Achromobacter xylosoxidans is a gram negative non-fermentative rod that infects adult cystic fibrosis patients with moderate to severe lung compromise. Its clinical implications are still to be determined. The aim of this study was to analyze the impact of inhaled imipenem on forced expired volume in 1 sec (FEV1) and number of exacerbations in adult cystic fibrosis patients. Patients colonized by A. xylosoxidans with more than two intravenous antibiotic cycles and/or ≥ 5% FEV1 impairment during the last year were included. We included six patients with a mean age of 24.8 years. At the beginning of treatment FEV1 was 1.18 l (52%) with a mean of 3.4 exacerbations in the previous 12 months and 2.24 (p=0.04) the following 12 months. There was a significant difference between the initial FEV1 value and three months after treatment (p=0.005).

Existe un mayor impacto de la tos en la calidad de vida según el pronóstico de bronquiectasias

the level of control, 77.3% considered it a useful method for diagnosis and 82.9% for determining asthma control. During the meeting itself, an interactive discussion took place among the audience and 5 of the authors of this article (VP, BGC, LME, LPLL and JMO). Controversial aspects associated with FENO and, primarily, the approach to different clinical cases associated with the usefulness of the technique in the diagnosis and control of asthma were debated. After this discussion, 3 key questions were put to the audience, with several options for response, on which the attendees voted in situ at the end of the meeting (Table 1B). The results were even more favorable than those of the earlier questionnaire: 95.2% of the group believed that FENO was a useful complementary technique in asthma for diagnosis and 90.3% found it useful for determining control (55.3% “in all cases”; plus 35.5% “only in patients with allergic asthma”). In short, the opinion of the multidisciplinary group of stakeholders and experts in asthma attending the AMP-2017 meeting was largely favorable to incorporating the measurement of FENO in clinical practice. Until the role of this examination is definitively determined in new studies, the results of this discussion should perhaps be considered in future editions of clinical practice guidelines in asthma.

Polineuropatía periférica en un paciente con enfermedad pulmonar obstructiva crónica grave

. Hauri-Hohl A, Baenziger O, Frey B. Pneumomediastinum in the neonatal and paediatric intensive care unit. Eur J Pediatr. 2008;167:415–8. . Iver VN, Joshi AY, Ryu JH. Spontaneous pneumomediastinum. Analysis of 62 consecutive adult patients. Mayo Clin Proc. 2009;84:417–21. Carlos A. Rombolá a,∗, Mariela S. Plenc b y Pablo León Atance a a Servicio de Cirugía Torácica, Complejo Hospitalario Universitario