Consensus Document on the Diagnosis and Treatment of Chronic Bronchial Infection in Chronic Obstructive Pulmonary Disease. / Documento de consenso sobre el diagnóstico y tratamiento de la infección bronquial crónica en la enfermedad pulmonar obstructiva crónica.

Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee.

[Azithromycin therapy in cystic fibrosis]. / Tratamiento con azitromicina en la fibrosis quística.

Progressive lung disease, caused by chronic endobronchial colonization, is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Several pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa are responsible for this effect. The steadily improving prognosis of CF has been attributed to the use of antibiotics with activity against these organisms. Despite a significant increase in the amount of published material demonstrating the potential role of macrolide antibiotics as antiinflammatory agents and their effects on bacterial virulence, their mechanism of action in CF patients is still unknown. Although there is a limited number of clinical trials assessing the efficacy and safety of azithromycin (AZM) in CF, increasing evidence suggests that 3 to 6-month AZM treatment in CF patients is safe and well tolerated. This treatment results in clinical improvement, decreasing the number of pulmonary exacerbations and increasing pulmonary function. Therefore, chronic treatment with AZM should be considered in CF patients added to conventional therapy. Clinical experience with macrolides other than AZM in CF patients is very limited.

[Interpretive reading of the antibiogram: Intellectual exercise or clinical need?]. / Lectura interpretada del antibiograma: 'ejercicio intelectual o necesidad clínica?

Clinical categorisation of susceptibility testing results according to criteria established by different committees is daily performed in clinical microbiology laboratories. By this process clinicians can predict the therapeutic success of antimicrobial treatment in patients infected with susceptible microorganisms. In addition, microbiology laboratories that include a suitable number of antimicrobial agents in susceptibility tests can perform interpretive reading of the antibiogram. With this approach, resistance phenotypes are recognized and allow microbiologist: a) detection of mechanisms of resistance, including low levels of expression; b) modification of clinical classifications that are inconsistent with the inferred resistance mechanism; and c) inference of susceptibility values for antimicrobials that are not included in the antibiogram. In the laboratory, this approach facilitates quality control and validation of susceptibility results. Moreover, it increases the value of the results obtained because new mechanisms of resistance can be characterized and the epidemiology of resistance can be established. From the clinical point of view, this approach contributes to improving the adequacy of treatment (since it is useful for predicting therapeutic failure with the use of antimicrobials in patients with infections due to resistant microorganisms) and to controlling and defining antimicrobial policies. Despite the growing complexity of resistance mechanisms, which makes interpretative reading of the antibiogram difficult, this process should be incorporated into routine practice in microbiology laboratories. Interpretive reading of antibiograms is clinically necessary and not simply a intellectual exercise.