[Prospective study of 221 community acquired pneumonias followed up in an outpatient clinic. Etiology and clinical-radiological progression]. / Estudio prospectivo de 221 neumonías adquiridas en la comunidad seguidas de forma ambulatoria. Etiología y evolución clinicorradiológica.

BACKGROUND: All the community acquired pneumonia followed up in an outpatient clinic were prospectively studied in order to determine: etiology, clinical-radiological characteristics and its progression with diagnostic and therapeutic protocols. PATIENTS AND METHOD: We arranged clinical evaluation protocols, etiological diagnosis by means of serology (in the first visit and three weeks later); and when necessary, by means of fiberbronchoscopy (protected microbiological brush), as well as clinical and radiological progression (up to three visits) after empirical treatment. RESULTS: Initially, 240 patients were included, of which 221 were fully followed up. Etiological diagnosis was obtained in 86 patients (39%). The bacteria most frequently isolated was Coxiella burnetii (12.2%), followed up Mycoplasma pneumoniae and Legionella pneumophila. Two cases of Strepcococus pneumoniae were diagnosed. The most frequent radiological onset was alveolar infiltrate (86%). The initial empiric treatment were macrolids (71%) or second generation cephalosporines (22%). Most patients presented a favourable clinical and radiological progression. Only 2 patients needed admission to the hospital (< 1%). CONCLUSIONS: In community acquired pneumonias studied in our outpatient clinic we found a high number of "atypical" agents. Treatment with macrolids or second generation cephalosporines are appropriate for these patients.

[Pulmonary infection in patients with lung cancer]. / Infección pulmonar en pacientes con cáncer de pulmón.

BACKGROUND: To determine the frequency of pneumonia in patients with primary lung cancer requiring hospital admission, the etiologic diagnosis, probable production mechanisms, and the factors which may condition the evolution. METHODS: A prospective study was carried out in patients with primary lung cancer requiring hospital admission between 1986-1990. The diagnosis of pneumonia was performed by clinical and radiologic criteria and the etiology, in all cases, by hemocultures, pulmonary aspiration puncture, transtracheal aspiration and bronchoscopic techniques. RESULTS: The frequency of pneumonia was 12%. Etiologic diagnosis of the pulmonary infection was achieved in 16 patients and the most frequent etiologic agents were Gram negative (56%), anaerobic (31%) and Pneumocystis carinii (31%). Mortality was 16%. Community or nosocomial infection was not related with the evolution of the lung infection. Neither did diagnosis of the etiologic agent condition mortality attributable to the pneumonia but facilitated treatment. CONCLUSIONS: Pulmonary infection is a frequent and severe disease in patients with primary lung cancer. Bronchial obstruction may be the related pathogenic mechanism in the greatest number of cases with pneumonia. Due to the etiologic spectrum of these infections the practice of reliable diagnostic techniques is recommended to obtain etiologic diagnosis in addition to the administration of initial wide spectrum empiric antibiotherapy against the mentioned germs.

Diagnostic value of the blind brush in mechanically ventilated patients with nosocomial pneumonia.

OBJECTIVES: To check on the accuracy of a new protected blind brush (BB) inserted through an endotracheal tube to collect respiratory secretions to be used in the diagnosis of nosocomial pneumonia (NP) in ventilated patients. DESIGN: Prospective study of patients who had undergone both BB and plugged telescoping catheter via fiberoptic bronchoscopy (PTC-FB) sample collection sessions. SETTING: Intensive Care Unit of a referral-based University Hospital. PATIENTS: All patients (n = 37) mechanically ventilated for more than 3 days with clinical and radiological criteria of NP between July 1990 and March 1991. INTERVENTIONS: Randomized BB and PTC-FB sample collection sessions carried out less than 30 min apart. MEASUREMENTS AND MAIN RESULTS: The two sampling procedures resulted in similar findings with both cultures either negative or positive and identified the same organism and colonies in 31 patients (83.7%). Agreement was 90% when the patients with right or bilateral pulmonary infiltrates were grouped together and 100% when only the right field was considered. Complications arising from BB sampling were much lower than those from the conventional PTC-FB technique. CONCLUSIONS: Our results, pending confirmation by other prospective studies, indicate that BB sampling is useful in the diagnosis of NP in ventilated patients with radiological evidence of either right or bilateral pulmonary infiltrates and that it could stand in for PTC-FB in ICU settings where this procedure is not available.