Susceptibilidad in vitro de bacterias anaeróbicas en infecciones pleuropulmonares / In vitro antimicrobial susceptibility of anaerobic bacteria isolated from pleuropulmonary infections

Background: Aspirative pleuropulmonary infections are usually caused by anaerobic flora of the mouth, mainly Prevotella, Fusobacterium and Peptostreptococcus spp. Penicillin in high doses is the traditional treatment for this type of infections but the rising resistance developed in recent years has induced the empiric use of clindamycin, increasing treatment costs. Aim: To study antimicrobial susceptibility of anaerobic bacteria isolated from pleuropulmonary infections. Material and methods: Thirty two strains obtained from bronchoalveolar lavage and 15 strains isolated from pleural effusions between 2000 and 2002, were studied. The phenotype of strains was identified using the semiautomated API 20 A method and their susceptibility to penicillin (PNC), clindamycin (CM) and chloramphenicol (CAF) was tested using the E test methods. Results: All the strains were susceptible to CAF, 95% to CM and 74.4% to PNC. The predominant genus was Prevotella, which also exhibited the higher resistance. Conclusions: As CM and CAF are active "in vitro", high rates of clinical response should be expected. In contrast, PNC is less effective, especially against pigmented Prevotella.

Rendimiento de la biopsia, cepillado y lavado bronquial por fibrobroncoscopia en el diagnóstico de cáncer pulmonar con lesiones visibles endoscópicamente / Yield of biopsy, brushing and bronchial washing through fiberbronchoscopy in the diagnosis of lung cancer with visible lesions

BACKGROUND: The combination of endobronchial biopsy with cytological brushing is considered the best procedures for the diagnosis of lung cancer during bronchoscopy. AIM: To asses the diagnostic yield for lung cancer (with visible endobronchial alterations at endoscopy) of three fiberoptic bronchoscopy procedures: endobronchial biopsy, cytological brushing and bronchial cytological washings. MATERIAL AND METHODS: Prospective study of 160 consecutive patients referred for fiberoptic bronchoscopy for clinically suspected lung cancer. Sequential bronchial washing, brushing and biopsies, were performed to all patients with a visible endobronchial alteration. RESULTS: One hundred and nine patients had a visible endobronchial alteration at fiberoptic bronchoscopy, but only 86 of them completed the protocol (21 patients were not subjected to the three diagnostic bronchoscopy procedures, because of bleeding or tolerance problems, and in two patients all the data required was not available). In twenty three, the diagnosis was a benign lesion, whereas lung cancer was diagnosed in 63. Fifty four of these 63 patients had at least one of the three endoscopic procedures (endobronchial biopsy, cytological brushing and bronchial cytological washings) positive for lung cancer (85.7%). The association of endobronchial biopsy with cytological brushing was positive for lung cancer in 49 cases (78%), and was the best association of two procedures. The diagnostic yield of each procedure was: endobronchial biopsy 50/63 (79%), cytological brushing 18/63 (28.5%). CONCLUSIONS: The best yield for the diagnosis of lung cancer is obtained with the association of the two procedures (endobronchial biopsy, cytological brushing). Cytological washings have a very low diagnostic yield.

Estudio de sensibilidad in vitro de cepas de streptococcus pneumoniae de infecciones respiratorias bajas en el Instituto Nacional del Tórax / In vitro susceptibility of streptococcus pneumoniae strains isolated from lower respiratory infections at the Instituto Nacional del Tórax

Background: The rising antimicrobial resistance of streptococcus pneumonió, requires permanent surveillance. Antimicrobial treatments of invasive infections must be modified accordingly. Aim: To assess the in vitro antimicrobial susceptibility of streptococcus pneumonió strains isolated from lower respiratory infections. Material and methods: Seventy five strains isolated during three periods in consecutive years were studied. In vitro susceptibility towards penicillin, erythromycin and ceftriaxone was studied using E-test technique minimal inhibitory concentrations. Results: Five percent of strains were penicillin resistant and 11 percent had an intermediate sensitivity. Erythromycin resistance was observed in 1.3 percent of strains. Eight percent of strains had an intermediate sensitivity towards ceftriaxone and no resistance was observed. Comparing susceptibility in the three studied periods, it remained low and stable. Conclusions: High and intermediate resistance of Strepfococcus pneumonió towards penicillin is less prevalent than in other countries. A close surveillance must be maintained

Tromboembolismo pulmonar relacionado a síndrome antifosfolípido y lupus eritematoso sistémico / Pulmonary thromboembolism associated to antiphospholipid syndrome and systemic lupus erythematosus

The association between systemic lupus erythematosus and antiphospholipid syndrome can cause several complications. We report a 45 years old woman, treated with steroids for a systemic lupus erythematosus. She presented with a clinical picture of a lupus pneumonitis and, subsequently, with the picture of a pulmonary thromboembolism. The diagnosis was confirmed by helicoidal computed axial tomography. The patient was treated with anticoagulants, with a favourable outcome

Profilaxis antibiótica en la colecistectomía por colecistitis aguda / Antibiotic prophylaxis in cholecistectomy for acute cholecistitis

Con el fin de evaluar la utilidad de la profilaxis antibiótica en colesistectomía por colecistitis aguda efectuamos un trabajo prospectivo randomizado en 81 pacientes, 39 pacientes recibieron el esquema antibiótico de ampicilina 1 gr. EV y gentamicina 1,5 mg. x Kg. de peso IM, una hora antes de la operación. No se observó infección de nigún tipo en niguno de los 2 grupos; y sólo hubo un caso de fiebre postoperatoria en cada grupo, que fueron tratados satisfactoriamente con antibióticos. De acuerdo a estos resultados, no recomendamos el uso de antibióticos profilácticos en la colecistectomía por colecistitis aguda, en pacientes en las que se espera tabla de complicaciones sépticas inferior al 5%