[Monotherapy vs. combined therapy in the treatment of multi-drug resistance gramnegative bacteria]. / Monoterapia vs. terapia combinada en el tratamiento de las infecciones por bacterias gramnegativas multirresistentes.

The increasing number of multidrug resistant gram negative bacteria, particularly in patients with risk factors, but in those who suffer community infections as well, is doing more and more difficult to choose the appropriate treatment. The most challenging cases are due to the production of extended-spectrum-ß-lactamases (ESBL) and carbapenemases. This mini-review will discuss the adequacy of administering carbapenems when suspecting infections due to ESBL that could be modified after knowing the MIC of the isolated bacteria and the combined therapy in cases of carbapenemases, being particularly important to include a carbapenem and/or colistine at high dosages in this combination.

Toxicidad pulmonar por interleucina-2 / Pulmonary toxicity due to interleukin-2

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Pericarditis neumocócica: presentación de un caso y revisión de la literatura / Pneumococcal pericarditis: presentation of one case and review of the literature

La pericarditis purulenta es una entidad rara en la actualidad, de curso rápidamente fatal en ausencia de tratamiento y de difícil diagnóstico clínico antes de la aparición de taponamiento pericárdico. Producida clásicamente por gérmenes aerobios grampositivos, la incidencia de etiología anaerobia, gramnegativa y fúngica parece aumentar. La etiología neumocócica es hoy excepcional y prácticamente siempre acompañando a una infección pleuropulmonar evidente. Las bases del tratamiento son la pericardiocentesis precoz, la antibioterapia intravenosa de amplio espectro y el tratamiento de soporte en una Unidad de Cuidados Intensivos. La técnica de drenaje pericárdico idónea en estos pacientes continúa siendo tema de controversia, dada la escasa experiencia clínica existente. El pronóstico es bueno si el reconocimiento es precoz, con una tasa de secuelas relativamente baja, generalmente en forma de pericarditis constrictiva. Presentamos un caso de pericarditis purulenta neumocócica primaria y una revisión de la literatura al respecto

Purulent pericarditis is a rare entity at present, with a rapidly fatal course in absence of treatment. Its clinical diagnosis is difficult due to the appearance of pericardial tamponade. Classically produced by Gram positive aerobic germs, the incidence of anaerobic, Gram negative and fungal etiology seems to increase. Pneumococcal etiology is rare today and almost always accompanies a clear pleuropulmonary infection. Treatment bases are early pericardiocentesis, intravenous wide spectrum antibiotic treatment and support treatment in the intensive care unit. The best pericardial drainage technique in these patients continues to be debatable, given the limited existing clinical experience. Prognosis is good if recognized early, with a relatively low sequel rate, generally as constrictive pericarditis. We present a case of primary purulent pneumococcal pericarditis and a review of the literature in this regards