¿Tienen los cirujanos más dificultades en la atención de los pacientes hospitalizados no intervenidos respecto a los intervenidos? / Do surgeons have more difficulties in the hospital care of non-surgery patients than with surgery patients?

OBJETIVO: Un porcentaje variable de los enfermos ingresados en los servicios quirúrgicos no son operados por diversas razones. Nuestro objetivo es comprobar si los cirujanos tienen más dificultades en la atención de los pacientes ingresados no operados que en los operados. MATERIAL Y MÉTODOS: Hemos incluido a todos los pacientes de edad ≥ 14 años dados de alta el año 2010 de Cirugía General, Ginecología, Urología y Otorrinolaringología. Las variables principales fueron la estancia, mortalidad, reingresos y número de interconsultas solicitadas a servicios médicos. Las variables secundarias: edad, sexo, número de ingresos urgentes, número total de diagnósticos y el índice de comorbilidad de Charlson (ICh). RESULTADOS: Entre el 8,7 y el 22,8% de los pacientes ingresados en estos servicios no son operados. Los pacientes no operados tienen significativamente mayores estancia, mortalidad, reingresos y solicitudes de interconsultas que los operados, con significativamente mayores edad (excepto Urología), número de diagnósticos, ingresos urgentes e ICh (excepto Urología). CONCLUSIONES: Los pacientes ingresados en los servicios quirúrgicos que no son operados tienen mayor mortalidad, reingresos y solicitudes de interconsultas que los operados, probablemente por su mayor complejidad médica y urgencia del ingreso. Ello podría indicar una mayor dificultad en su manejo por parte de los cirujanos

OBJECTIVE: A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. MATERIAL AND METHODS: We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). RESULTS: Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). CONCLUSIONS: Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons

Resultados de una intervención de descolonización de Staphylococcus aureusen pacientes portadores a los que se indica una prótesis articular / Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty

INTRODUCCIÓN: La infección de prótesis articular (IPA) es una complicación con graves repercusiones cuyo principal agente responsable en la mayoría de los casos es Staphylococcus aureus. El propósito del presente estudio es evaluar si la descolonización de los pacientes portadores de S. aureus a los que se indica una prótesis articular consigue una disminución en la incidencia de IPA por S. aureus. MATERIAL Y MÉTODOS: Estudio de intervención antes-después en el que se comparó la incidencia de IPA en pacientes bajo cirugía de prótesis articular de rodilla o cadera entre enero y diciembre de 2011 a los que se realizó estudio de detección de colonización nasal por S. aureus y erradicación si procedía, con un protocolo de mupirocina intranasal y ducha con clorhexidina, con respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2010. RESULTADOS: En el período de control se realizaron 393 artroplastias en 391 pacientes. En el período de intervención se implantaron 416 prótesis en 416 pacientes. Se realizó estudio de colonización a 382 pacientes (91,8%), de los que 102 fueron positivos (26,7%) y se trataron según el protocolo. Se produjeron 2 casos de de IPA por S.aureus frente a 9 en el año control (0,5% vs 2,3%, odds ratio [OR]: 0,2, intervalo de confianza [IC] del 95%: 0,4 a 2,3, p = 0,04). CONCLUSIÓN: En nuestro estudio la aplicación de un protocolo de detección de colonización/ erradicación de S.aureus consiguió un descenso significativo de la incidencia de IPA por S.aureus respecto a un control histórico

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S. aureuscarriers helps to reduce the incidence of PJI by S. aureus. MATERIAL AND METHODS: An S. aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010.RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S. aureuscompared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P = .04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group

DoSurgeons Have More Difficulties in the Hospital Care of Non-surgery Patients Than With Surgery Patients?

OBJECTIVE: A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. MATERIAL AND METHODS: We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). RESULTS: Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). CONCLUSIONS: Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons.

[Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty]. / Resultados de una intervención de descolonización de Staphylococcus aureus en pacientes portadores a los que se indica una prótesis articular.

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S.aureus carriers helps to reduce the incidence of PJI by S.aureus. MATERIAL AND METHODS: An S.aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010. RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S.aureus compared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P=.04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group.

Respuesta: Acerca de la interconsulta médica / Reply: About medical interconsultation

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Effectiveness and safety of thromboprophylaxis with enoxaparin in medical inpatients.

BACKGROUND: Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Although effective prophylaxis exists for medical patients, there is little information outside of clinical trials. We will analyze our experience in the prophylaxis of VTE with enoxaparin in hospitalized medical patients. MATERIAL AND METHODS: We studied all of the patients ≥15 years admitted for emergency care to all of the medical departments of the hospital, except for the Hematology Department, between 1/April/1999 and 31/December/2005. The patients' age, sex, Charlson comorbidity index (CCI), whether they received prophylaxis with enoxaparin or not, dose, VTE, bleeding, thrombocytopenia, and mortality were analyzed. RESULTS: 40,349 patients were included, of which 55.87% were male, with an average age of 67.56, and an average CCI of 4.99. There were 19,834 patients who did not receive prophylaxis for which the rate of incidence of VTE was 0.61%, mortality 8.75%, bleeding 1.38%, and thrombocytopenia 0.04%. Prophylactic enoxaparin was administered to 20,515 patients, for which the rate of incidence of VTE was 0.44%, mortality 10.71%, bleeding 1.1%, and thrombocytopenia 0.04%. The adjusted Odds Ratio (OR) for VTE was 0.65 (95% confidence interval [95% CI] 0.49 to 0.87). The adjusted OR for mortality was 0.84 (95% CI 0.78 to 0.9). With the adjusted data, the number needed to treat (NNT) for VTE was 470.3 (95% CI 278.4 to 1413.3), and the NNT for mortality was 77.2 (95% CI 54.6 to 130.3). CONCLUSION: Thromboprophylaxis with enoxaparin in hospitalized medical patients is associated with a lower incidence of VTE and mortality, and is safe.

La interconsulta médica: problemas y soluciones / Medical consultation: Problems and solutions

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[Factors that influence interdepartmental referrals between Surgical Departments and Internal Medicine]. / Factores que influyen en la solicitud de interconsultas a medicina interna por los servicios quirúrgicos.

INTRODUCTION: To analyse the long term outcome of the age and comorbidity of patients admitted to Surgical Departments, the number of referrals to Internal Medicine made by these Departments, and to assess whether there are seasonal variations and the call/reject effect. MATERIAL AND METHODS: We compared the age, Charlson Comorbidity Index (CCI), and the number of referrals made by Traumatology, General Surgery and Urology of patients discharged in 2000, with those discharged in 2007. Seasonal variations and the call/reject effect were studied by analysing all the interdepartmental referrals made by all the surgical departments from the year 2000 to 2007. RESULTS: Age increased by 5.6% between 2000 and 2007, the CCI by 5.8%, and interdepartmental referrals by 60%. Interdepartmental referrals decreased in July and August, whilst they increased in January, February, June and October, up to 64% more in January, although with variations of almost 50% in the same month. We detected differences of up to 68.2% in the referrals requested to different physicians. CONCLUSIONS: We observed a sharp increase in the requests for referral to Internal Medicine by Surgical Departments of our hospital, which is not explained by the increase in admissions to these Departments, and which could be associated with the increase in age and comorbidity of their patients. Requests for interdepartmental referral have marked monthly variations and also as regards the Consulting Physician.

Factores que influyen en la solicitud de interconsultas a medicina interna por los servicios quirúrgicos / Factors that influence interdepartmental referrals between Surgical Departments and Internal Medicine

Objetivo Analizar la evolución de la edad y la comorbilidad de los pacientes ingresados en los servicios quirúrgicos, el número de interconsultas pedidas por dichos servicios a medicina interna y valorar la existencia de variaciones estacionales y efecto llamada/rechazo en su solicitud. Material y métodos Comparamos la edad, el índice de comorbilidad de Charlson (ICh) y el número de interconsultas solicitadas de los pacientes dados de alta en 2000 con los de 2007, de traumatología, cirugía general y urología. Estudiamos las variaciones estacionales y el efecto llamada/rechazo analizando todas las interconsultas solicitadas por todos los servicios quirúrgicos del hospital desde 2000 hasta 2007.ResultadosEntre 2000 y 2007 la edad aumentó el 5,6%; el ICh, el 5,8% y las interconsultas, el 60%. En julio y agosto se reduce la solicitud de interconsultas, mientras que en enero, febrero, junio y octubre se incrementan, hasta un 64% más en enero, aunque con variaciones dentro de un mismo mes de hasta casi el 50%. Detectamos diferencias que alcanzan el 68,2% en la solicitud de interconsultas a los diferentes internistas. Conclusiones Observamos un fuerte ascenso en la solicitud de interconsultas a medicina interna por los servicios quirúrgicos de nuestro hospital, que no se explica por el aumento de ingresos en dichos servicios, y que puede estar en relación con el incremento de la edad y la comorbilidad de sus enfermos. La petición de interconsultas presenta marcadas variaciones mensuales y también con respecto al internista consultor (AU)

Introduction To analyse the long term outcome of the age and comorbidity of patients admitted to Surgical Departments, the number of referrals to Internal Medicine made by these Departments, and to assess whether there are seasonal variations and the call/reject effect. Material and methods We compared the age, Charlson Comorbidity Index (CCI), and the number of referrals made by Traumatology, General Surgery and Urology of patients discharged in 2000, with those discharged in 2007. Seasonal variations and the call/reject effect were studied by analysing all the interdepartmental referrals made by all the surgical departments from the year 2000 to 2007.ResultsAge increased by 5.6% between 2000 and 2007, the CCI by 5.8%, and interdepartmental referrals by 60%. Interdepartmental referrals decreased in July and August, whilst they increased in January, February, June and October, up to 64% more in January, although with variations of almost 50% in the same month. We detected differences of up to 68.2% in the referrals requested to different physicians. Conclusions We observed a sharp increase in the requests for referral to Internal Medicine by Surgical Departments of our hospital, which is not explained by the increase in admissions to these Departments, and which could be associated with the increase in age and comorbidity of their patients. Requests for interdepartmental referral have marked monthly variations and also as regards the Consulting Physician (AU)

Respuesta de los autores: Publicación de los ensayos clínicos aleatorizados: normativas existentes en la actualidad para garantizar su validez, fiabilidad y transparencia / Author’sreply: Publication of randomized clinical trials: Current existing legislations to guarantee their validity, reliability and transparency

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Fiabilidad de los ensayos clínicos aleatorizados publicados / No disponible

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Seguimiento clínico de pacientes en los servicios de traumatología. Respuesta del autor / Clinical follow-up of patients in traumatology departments. Reply

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[Prognostic factors of clinical outcome of the tuberculous pleural effusion]. / Factores pronósticos de la evolución clínica del derrame pleural tuberculoso.

BACKGROUND AND OBJECTIVE: To date, no studies have been reported analyzing the prognosis factors related to severe clinical complications in tuberculous pleural effusion (TPE). We studied clinical, biochemical, radiological, and microbiological factors that could help establish the clinical outcome of TPE. PATIENTS AND METHOD: Retrospective study of > or = 15 years old patients diagnosed of TPE along 9 years. Patients were classified in two groups: a group without complications (NCG), and a group with complications (CG) on the basis of residual pleural thickening (RPT) > or = 10 mm, need of surgery or death. RESULTS: Sixty six patients were included, mean age 35.3 years, 53% male, 47 in the NCG group and 19 in the CG (1 died, 4 needed surgery, 14 had RPT). The evolution of clinical symptoms was 20.7 days in the NCG and 45.6 in the CG. 94.7% of the CG patients had loculations (23.4% in the NCG). We observed significant differences in the pH (7.34 vs 7.11), glucose (78 vs 30 mg/dl) and lactic dehydrogenase (925 vs 3,235 U/l). CONCLUSIONS: Severe TPE has similar characteristics to complicated parapneumonic pleural effusion. Loculations, pH < 7.25 and glucose < 50 mg/dl were indicative of a poorly outcome in our study.

Factores pronósticos de la evolución clínica del derrame pleural tuberculoso / Prognostic factors of clinical outcome of the tuberculous pleural effusion

FUNDAMENTO Y OBJETIVO: No hay publicaciones sobre factores pronósticos de complicaciones clínicas graves en el derrame pleural tuberculoso(DPT). El objetivo de este trabajo fue estudiar la existencia de factores clínicos, bioquímicos, radiológicos microbiológicos que puedan establecer el pronóstico clínico del DPT.PACIENTES Y MÉTODO: Estudio retrospectivo de los pacientes de 15 años o mayores diagnosticados de DPT durante 9 años, divididos en un grupo sin complicaciones (SC) y un grupo con complicaciones (CC) si presentaron engrosamiento pleural residual (EPR) de 10 mm o más, precisaron cirugía o fallecieron. RESULTADOS: El estudio incluyó a 66 pacientes con una edad media de 35,3 años; un 53%eran varones. Había 47 pacientes en el grupo SC y 19 en el CC (1 fallecido, 4 intervenidos quirúrgicamente, 14 con EPR). El tiempo de evolución de los síntomas fue de 20,7 días en el grupo SC y de 45,6 en el CC. El 94,7% delos pacientes CC presentó loculaciones frente al 23,4% en el grupo SC. Encontramos diferencias significativas en el pH (7,34 frente a7,11), glucosa (78 frente a 30 mg/dl) y lactato deshidrogenasa(925 frente a 3.235 U/l).CONCLUSIONES: El DPT grave tiene características similares al derrame para neumónico complicado. El perfil pronóstico de mala evolución clínica está compuesto por la presencia de loculaciones, pH inferior a 7,25 y glucosa menor de 50 mg/dl

BACKGROUND AND OBJECTIVE: To date, no studies have been reported analyzing the prognosis factors related to severe clinical complications in tuberculous pleural effusion (TPE). We studied clinical, biochemical, radiological, and microbiological factors that could help establish the clinical outcome of TPE.PATIENTS AND METHOD: Retrospective study of ≥15 years old patients diagnosed of TPE along 9years. Patients were classified in two groups: a group without complications (NCG), and a group with complications (CG) on the basis ofresidual pleural thickening (RPT) ≥10 mm, need of surgery or death. RESULTS: Sixty six patients were included, meanage 35.3 years, 53% male, 47 in the NCGgroup and 19 in the CG (1 died, 4 needed surgery,14 had RPT). The evolution of clinical symptoms was 20.7 days in the NCG and 45.6in the CG. 94.7% of the CG patients had loculations(23.4% in the NCG). We observed significant differences in the pH (7.34 vs 7.11), glucose(78 vs 30 mg/dl) and lactic dehydrogenase(925 vs 3,235 U/l)

[Effect derived by the adscription of internist to a surgical department]. / Efecto de la adscripción de internistas a un servicio quirúrgico.

BACKGROUND AND OBJECTIVE: Although surgical units commonly request the collaboration of internists via medical consultation, the efficiency of this system is low and expensive. We studied the effect of the integration of full-time internists in a surgical department. PATIENTS AND METHOD: The study group consisted of the patients admitted during intervention in the Orthopedic Surgery and Traumatology Department. Those patients admitted during the same period of the previous year made up the control group. We analyzed pre-surgical stay, post-surgical stay and total stay. We also studied in-hospital mortality, re-admissions and those patients who were not submitted to surgery (NSS). Control variables were age, sex, type of admission (programmed/emergency) and main diagnosis. RESULTS: 1,216 patients were included, 599 in the control group and 617 in the study group, 48.0% were emergency admissions and 11.7% NSS patients. Study of programmed patients did not suggest any differences between both groups in any of the analyzed variables. In emergency patients, the total stay was decreased in 18.2%, and it was reduced in 40.2% of the NSS. The distribution of the re-admissions was similar in both study and control groups. We observed a decrease in the NSS and a 50% decrease in the deaths of the study group. The obtained saving was 329,170 Euros. CONCLUSIONS: The adscription of full-time internists to a surgical service clearly improves the quality of the service it provides, with important hospital savings.

Efecto de la adscripción de internistas a un servicio quirúrgico / Effect derived by the adscription of internist to a surgical department

FUNDAMENTO Y OBJETIVO: Los servicios quirúrgicos solicitan la colaboración de internistas por medio de la interconsulta médica. Este sistema es poco eficaz y caro. Estudiamos el efecto de la integración de internistas a tiempo completo en un servicio quirúrgico. PACIENTES Y MÉTODO: El grupo estudiado estuvo constituido por los pacientes ingresados en el Servicio de Cirugía Ortopédica y Traumatología durante los 5 meses que estuvieron adscritos los internistas. El grupo control lo integraron los pacientes ingresados en el mismo período del año anterior. Se analizó la estancia prequirúrgica, posquirúrgica y total, la mortalidad intrahospitalaria, los reingresos y los pacientes no sometidos a cirugía (NSC). Las variables de control fueron la edad, el sexo, el tipo de ingreso (programado/urgente) y el diagnóstico principal. RESULTADOS: Estudiamos a 1.216 pacientes con una edad media de 53,2 años (599 en el grupo control y 617 en el de estudio). El 51,9% fueron mujeres; el 48,0%, ingresos urgentes y el11,7%, pacientes NSC. Los programados no presentaron diferencias entre ambos grupos en ninguna de las variables analizadas. En los urgentes la estancia total disminuyó el 18,2%, la posquirúrgica el 24,2% y los NSC el 40,2%. En los ingresos totales, la estancia total disminuyó el 14,0%, la posquirúrgica el 17,9% y la de los pacientes NSC un 37,0%. La distribución de reingresos fue similar. Se observó un descenso de los NSC así como una disminución del 50%de los fallecimientos del grupo con internistas. El ahorro conseguido fue de 329.170 € .CONCLUSIONES: La adscripción de internistas a tiempo completo a un servicio quirúrgico mejora claramente la calidad de la asistencia prestada, con un ahorro importante en los costes

BACKGROUND AND OBJECTIVE: Although surgical units commonly request the collaboration ofinternists via medical consultation, the efficiency of this system is low and expensive. We studied the effect of the integration of full-time internists in a surgical department. PATIENTS AND METHOD: The study group consisted of the patients admitted during intervention in the Orthopedic Surgery and Traumatology Department. Those patients admitted during the same period of the previous year made up the control group. We analyzed pre-surgical stay, post-surgical stay and total stay. We also studied in-hospital mortality, re-admissions and those patients who were not submitted to surgery (NSS). Control variables were age, sex, type of admission (programmed/emergency) and main diagnosis. RESULTS: 1,216 patients were included, 599 in the control group and 617 in the study group,48.0% were emergency admissions and 11.7% NSS patients. Study of programmed patients did not suggest any differences between both groups in any of the analyzed variables. In emergency patients, the total stay was decreased in 18.2%, and it was reduced in 40.2% of the NSS. The distribution of the readmissions was similar in both study and control groups. We observed a decrease in the NSS and a 50% decrease in the deaths of the study group. The obtained saving was 329 170 Euros. CONCLUSIONS: The adscription of full-time internists to a surgical service clearly improves the quality of the service it provides, with important hospital saving

[Treatment of empyema and complicated pleural effusion with intrapleural fibrinolysis]. / Tratamiento con fibrinolisis intrapleural del empiema y el derrame pleural complicado.

BACKGROUND AND OBJECTIVE: Intrapleural fibrinolysis (IPF) can avoid surgery in patients with loculated pleural effusions. Few clinical trials on IPF for the treatment of empyemas (PEM) and complicated pleural effusions (CPE) have been reported. We describe here our experience with IPF in the treatment of PEM/CPE patients. PATIENTS AND METHOD: 81 patients with PEM/CPE were included. Urokinase, 100000 U, was instilled into the pleural cavity, three times a day. A mean of 12.9 doses of urokinase were administered. RESULTS: The mean of days having a chest tube was 7.7 days and the mean hospital stay was 22.2 days. No radiological sequelae were observed or these were mild in 66 cases (81.5%). There were four deaths and three patients needed surgery. CONCLUSIONS: IPF is an efective and reliable method for the treatment of PEM/CPE.

Tratamiento con fibrinolisis intrapleuraldel empiema y el derrame pleural complicado / Treatment of empyema and complicated pleural effusion with intrapleural fibrinolysis

FUNDAMENTO Y OBJETIVO: La fibrinolisis intrapleural (FIP) puede evitar la cirugía en pacientes con derrames pleurales loculados. Son escasos los ensayos clínicos y las series publicadas sobre su utilización en empiemas y derrames pleurales complicados (DPC).Describimos nuestra experiencia con la FIP en el tratamiento de empiemas y DPC.PACIENTES Y MÉTODO: El estudio incluyó a 81 pacientes con empiema y DPC, a los que se administró 100.000 U de urocinasa intrapleural cada 8 h, con una media de 12,9 dosis por paciente. RESULTADOS: El drenaje torácico permaneció una media de 7,7 días y la estancia media hospitalaria fue de 22,2 días. No se observaron secuelas radiológicas o fueron leves en 66 casos (81,5 por ciento). Cuatro pacientes fallecieron y tres requirieron cirugía. CONCLUSIONES: La FIP es una modalidad terapéutica efectiva y segura en el tratamiento de los empiemas y DPC. (AU)