Evaluación y manejo del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad, en un hospital de baja complejidad, basado en la Guía Clínica Chilena / Management of community acquired pneumonia in adults following clinical guidelines at a rural hospital

Background: A National Consensus Guideline published in 2005 established the basis for the diagnostic, severity assessment and treatment of community acquired pneumonia (CAP) in the adult population. The compliance with pneumonia clinical guidelines has been associated to a reduction in hospital stay healthcare-related costs, morbidity and mortality. Aim To describe the management and outcome of non-severe CAP in hospitalized adult patients treated in a rural hospital, based on the national clinical guidelines. Patients and methods: Ninety six patients aged 74 ± 13 years (50 males) hospitalized with non-severe pneumonia (group 3) at a community-based primary care center between January 1, 2006, and March 31, 2007, were evaluated. Results: Eighty percent of patients had concomitant diseases such as hypertension in 49 percent, diabetes in 23 percent and chronic obstructive pulmonary disease in 18 percent. All were treated with a third generation cephalosporin (ceftriaxone 1-2 g/day TV) as empirical therapy. Only 9 percent of patients also received a macrolide. Early switch to oral antimicrobial therapy was successful in two third of cases. Mean hospital length of stay was 5.0 ± 2.5 days, and 30-day mortality was 6.3 percent. Conclusions: Following the recommendations of the national clinical guidelines, most of these patients had a favorable response to monotherapy with a B-lactam antimicrobial. Early switch therapy to oral antibiotic was effective and safe, reducing significantly hospital length of stay as compared to previous national clinical studies.

Pneumonias comunitárias em adultos: como eu trato. Temas de Atualização e Revisão em Clínica Médica / Community pneumonias in adults: how I treat? Themes of Updating and Revision in Medical Clinic

Pneumonia comunitária é um problema comum na prática de clínica médica. O diagnóstico deve ser pensado em casos febris e(ou) com sinais e sintomas respiratórios, nos quais a radiografia torácica é fundamental nesta caracterização. Uma vez estabelecido o diagnóstico, devemos estratificar o paciente por grupos de risco para uma evolução desfavorável, aplicando critérios já bem estudados (CURB-65 e PSI) para definir hospitalização e a intensidade de cuidados médicos necessários. A avaliação clínico-epidemiológica ajuda na seleção da antibioticoterapia mais eficaz. Parâmetros de acompanhamento pragmáticos da resposta terapêutica, incluindo período pós-alta, são fornecidos.

Community acquired pneumonia is a fairly common problem in general practice. Clinical suspicion should arise in febrile cases, with or whitout respiratory symptoms, in which a chest radiograph is pivotal in the diagnosis. Once the diagnosis has been clinched, the patient should be risk stratified by groups, using well stablished criteria (CURB-65, PSI) to define hospital admission and level of medical care. Clinical epidemiologic analysis assists in the definition of the proper antimicrobial agent. Pragmatic therapeutic parameters of clinical response are provided (including post-dischargel).

Enterobacterias productoras de beta lactamasa de espectro expandido en pacientes críticos de la Maternidad Concepción Palacios / Expanded spectrum beta lactamase producting enterobacterias in crtical patients from Maternity Hospital

Dentro de los mecanismos de resistencia bacteriana encontrados en los miembros de las Enterobacteriaceae, las Beta Lactamasas de Espectro Expandido (BLEE), juegan un papel importante ya que debido a su naturaleza plasmídica pueden diseminarse a otros géneros diferentes a E. coli, K. pneumoniae y K. oxytoca, de donde principalmente se han descrito y confieren resistencia a cefalosporinas de tercera y cuarta generación y a aztreonam. Dado que en la Maternidad “Concepción Palacios” (MCP) la mayor parte de los pacientes constituyen neonatos y el tratamiento empleado principalmente son cefalosporinas, se evaluó la frecuencia en este centro de Enterobacterias productoras de BLEE aislados en áreas críticas de muestras de hemocultivos, puntas de catéter, orina y secreciones en el período comprendido de Enero a Junio de 2006. La identificación y sensibilidad se realizaron con las galerías ID32GN y ATBGN-5 respectivamente, utilizando el equipo semiautomatizado Mini API (BioMérieux). Para la detección fenotípica de producción de BLEE se empleó el método de doble difusión con discos y el método recomendado por el Clínical and Laboratory Standard Institute (CLSI) (1). La mayor frecuencia se obtuvo para Pantoea agglomerans, seguida de Klebsiella pneumoniae, y Enterobacter cloacae. El 80 % de las enterobacterias aisladas, fueron productoras de BLEE.

Inside the mechanisms of bacterial resistance found in members of the Enterobacteriaceae family, the Expanded Spectrum Beta Lactamasas (ESBL), play an important role due to its plasmid nature it can be spread to other different genera to E. coli, K.pneumoniae, and K. oxytoca, wherefrom principally they have been described, and award resistance to cephalosporin of third and fourth generation and to aztreonam. In view of the Maternity “Concepción Palacios” (MCP) most of the patients constitutes newborn, and the principally used treatment are cephalosporin, the frequency of ESBL producting enterobacteria was evaluated in this center, isolated in critical areas from samples of blood cultures, tops of catheter, urine and secretions from January to June, 2006. The identification and sensibility were realized by the galleries ID32GN and ATBGN-5 respectively, using the semi automated Mini API (BioMérieux) equipment. For the phenotypical detection of ESBL production there were used the double diffusion of disc method and the method recommended by the Clinical and Laboratory Standard Institute (CLSI) (1). The major frequency was to Pantoea agglomerans followed by Klebsiella pneumoniae, and Enterobacter cloacae. 80% of the isolated enterobacteria, were producer of ESBL.

Estudio comparativo de la actividad in vitro de antibióticos beta-lactámicos de uso reciente y aminoglucosidos de uso tradicional / Comparision study of the in vitro activity of beta-lactam antibiotics introduced recently and aminoglucosides of traditional use

Se realizó un estudio de la actividad in vitro que presentaron 2 antióticos beta-lactámicos de reciente uso terapéutico en nuestro medio: ceftriaxone (Rocephin) y cefotaxima (Claforan) y aquella que presentaron 2 aminoclucósidos tradicionales: gentamicina y amikacina. Los mismos fueron probados frente a cepas aisladas en pacientes graves, tanto niños como adultos, ingresados en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto". Los resultados obtenidos demostraron que los aminoglucósidos, especialmente la amikacina, fueron más eficaces que los beta-lactámicos probados